A Case Study of Management and Outcomes of Ovarian Cysts Detected During Pregnancy

Ovarian cysts are frequently discovered during pregnancy and can pose diagnostic and management challenges due to potential impacts on both the mother and fetus. This case examined the management approaches and outcomes for ovarian cysts identified during pregnancy.

A 23-year-old first-time pregnant woman, at 14 weeks and 5 days gestation, presented with abdominal pain and vomiting, without fever or urinary tract infection symptoms. A dating ultrasound revealed a large simple cystic mass measuring 9.2 x 12 cm, which increased in size to 12 x 18 cm upon follow-up at 14 weeks. The patient had taken letrozole for ovulation induction and had no notable medical, surgical, or family history.

Physical examination indicated a uterus just palpable and a cystic mass consistent with 28 weeks of gestation occupying all quadrants. Laboratory results showed cancer antigen (CA) 125 at 11.3, carcinoembryonic antigen (CEA) at 0.32, lactate dehydrogenase (LDH) at 224, and serum alpha fetoprotein (AFP) less than 0.495.

The patient underwent laparotomy and para-ovarian cystectomy, with histopathology confirming a simple serous cyst. The postoperative recovery was smooth. At 28 weeks, the patient experienced preterm premature rupture of membranes, leading to spontaneous labor and an assisted breech delivery of an 800-gram baby, who unfortunately passed away on day 15.

Accurate evaluation of ovarian cysts or masses during pregnancy is crucial for determining the best treatment options. Ultrasound and MRI are safe diagnostic tools that help differentiate between benign and malignant lesions. For cysts exhibiting benign characteristics, a "watchful waiting" approach may be appropriate. However, cysts with complex features, such as septations, solid components, or those persisting beyond 16 weeks or increasing in size, require further investigation and management. Treatment strategies should be tailored to individual patients based on the characteristics of the cyst and the stage of pregnancy, with considerations for both laparotomy and laparoscopy depending on tumor size, gestational age, and surgeon's expertise.

Source: Yalamaddi OD, Ethirajan S, Janarthanam S. A case series on navigating ovarian cysts during pregnancy assess the outcomes. Indian J Obstet Gynecol Res 2025;12(1):155-158.

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