Ovarian cysts in pregnancy: a narrative review

Abstract

Most adnexal masses are benign, incidental findings of pregnancy which resolve spontaneously. They may present clinically due to haemorrhage, rupture, torsion and mass effect. Aetiological classification includes ovarian benign, ovarian malignant, non-ovarian, gynaecological, non-ovarian non-gynaecological and an additional subset of pathologies unique to pregnancy. Ultrasound is the first-line imaging modality for the evaluation of adnexal masses. This may be supplemented with magnetic resonance imaging. Tumour markers support evaluation of malignant potential, but interpretation of results in pregnancy is challenging. Surgical intervention requires consideration of gestation, lesion characteristics and presence of complications. Laparoscopy is preferred owing to shorter operative time, quicker recovery and resultant lower thrombotic risk. Post-viability, fetal wellbeing and assessment must be considered. Management of the pregnancy may include cardiotocography, steroids, non-teratogenic antibiotics and tocolytics. In rare cases, particularly related to malignancy, termination of pregnancy may be required to enable immediate management where there are concerns for maternal wellbeing.

Keywords:

• Adnexal masses
• gestation
• ovarian tumours
• gynaecology oncology
• ultrasound
• tumour markers

Ethical approval

This manuscript is a narrative review paper and did not involve any clinical trials requiring registration.

Author contributions

The topic was conceived by PN and SS. The literature review was performed by SS, who also constructed the project outline and drafted the manuscript. This was edited, revised and endorsed by PN and AA.

Disclosure statement

No potential conflict of interest was reported by the author(s).