International Journal of

Reproduction, Contraception,
Obstetrics and Gynecology
Dahiya P et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):915-917
www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: 10.18203/2320-1770.ijrcog20150128
Case Report

Ovarian mass in pregnancy: a case report

Pushpa Dahiya, Latika*

Department of Obstetrics & Gynaecology, PT. B. D. Sharma, PGIMS, Rohtak, Haryana, India

Received: 04 April 2015

Accepted: 18 April 2015

*Correspondence:
Dr. Latika,
E-mail: latika.duhan@gmail.com

Copyright: the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Most common ovarian masses encountered during pregnancy are functional cysts of ovary and luteomas being unique
to pregnancy. The other ovarian masses in order are benign cystic teratomas, serous cystadenoma, paraovarian cyst,
mucinous cystadenoma and endometrioma. Torsion of ovarian cyst is the commonest complication during pregnancy.
Incidence of ovarian torsion is 5 per 10000 pregnancies. The diagnosis is established by the characteristic history,
presenting complaints of patient, examination findings and it is confirmed by the transvaginal ultrasound. Whenever
this complication is encountered, its important to go for immediate surgery. The surgical options available are
laparoscopy or laparotomy. Here we report about a patient who was G5P4L4 with 18 weeks period of gestation. She
presented in casualty with the chief complaints of acute pain abdomen on and off since morning. The patient was
taken up for the ultrasound which showed a live foetus of 16 weeks gestation with adenexal mass. In view of probable
diagnosis of torsion of adenexal mass, the patient was taken up for emergency laparotomy and ovarian cystectomy
was performed. Patients post-operative period was uneventful and on histopathological examination the ovarian mass
was found to be mucinous cystadenoma. Although, it is well established fact that surgery; if performed during second
trimester is safer in case of an ovarian mass, nevertheless there is always small amount of risk to the growing foetus.
Therefore, it is important to have choice of management for such cases depending on various factors viz. surgical
indication, patients condition, period of gestation. The appropriate decision should be taken after weighing all the
risks and taking well informed consent. Whenever complications like torsion, rupture of cyst, infarction arise, than
emergency surgery has to be taken up irrespective of period of gestation.

Keywords: Ovarian mass in pregnancy, Mucinous cystadenoma

often difficult due to non-
specific presenting
features. The various
pregnancy. The ovarian
INTRODUCTION predisposing factors often
torsion is defined as partial
seen associated with
or complete twisting of
torsion are moderate to
Most common ovarian masses encountered during pregnancyovary on its ligamentous large size of ovarian mass,
are functional cysts of ovary and luteomas being unique to supports, often resulting in
long pedicle and free
pregnancy.1 The other ovarian masses in order are benign impedance of its lymphatic
cystic teratomas, serous cystadenoma, paraovarian cyst, and venous outflow and mobility. The patient
mucinous cystadenoma and endometrioma.2 Wheneverarterial inflow leading to presents with severe,
malignancy is suspected in ovarian tumor during pregnancy, it stasis, venous congestion, colicky, unilateral and
is generally a germ cell tumour or borderline epithelial acute pain abdomen that is
ovarian tumour.4,5 These are generally of low stage and low haemorrhage, necrosis and usually non remitting but
sometimes cyst rupture.
grade and consequently prognosis is good. 4,5 The incidence of can wax and wane in cases
2 The exact etiology of
surgery during pregnancy is 1:1312. The torsion of ovarian of incomplete or
cyst is the commonest complication during torsion of ovary is not
intermittent ovarian
known and diagnosis is
torsion. On pelvic
examination, one might find tender
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Dahiya P et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):915-917
suspected torsion
of ovarian mass.
Peroperatively
gross morphology
cystic mass separated fromwas: Pedunculated
uterus. The incidence ofright sided
ovarian torsion is 5 permassive ovarian
3
10000 pregnancies and itscyst of size 18-20
risk increases 5 timescm approximately
during pregnancy. The
ovarian torsion is morewith presence of
commonly seen intwist with
reproductive age group.varigated
The majority of the casesconsistency and
presented in pregnantpunctate
(22.7%) than in non-haemorrhages
pregnant women (6.1%).6 (Figure 1 & 2).
The pedical of
CASE REPORT ovarian mass was
untwisted and
A 35 year old female,ovarian
G5P4L4 with 18 weeks ofcystectomy was
gestation presented indone. Other side
casualty with chiefovary and
complaints of acute painfallopian tube
abdomen on and off sincewere found to be
morning. The patientnormal. Patients
described pain over wholepost-operative
of abdomen, with noperiod was
aggravating or relievinguneventful. She
factors. There was nowas given uterine
history of nausea,relaxants,
vomiting, fever, syncopaltocolytics and
attack, bladder or bowelinjectable
complaints. There was noantibiotics for 48
history of discharge orhours.
bleeding per vaginum. HerHistopathology
previous menstrual cyclesreport came out to
were normal. Her obstetricbe mucinous
history was uneventful.cystadenoma and
All previous issues werepatients
alive and healthy. Therepregnancy
was no significant past,continued to be
personal or surgicalmonitored on OPD
history. On examinationbasis after
she was conscious anddischarge on 12th
coherent. Her BP waspostoperative day.
100/84 mm of Hg, pulse
rate was 110/minute and
she was afebrile to touch.
Abdomen examination
revealed uterine height
corresponding to 30 weeks
of gestation. The abdomen
was so tender that proper
examination couldnt be
performed. Differential
diagnosis of ?abruptio
placentae, ?appendicitis
was made. The patient was
taken for ultra sonography
which showed a live
foetus of 16 weeks Figure 1:
gestation along with big Peroperatively
gross
ovarian mass of mixed morphology
echogenecity with was:
increased blood flow. Pedunculated
Preliminary investigations right sided
were done and patient was massive ovarian
taken up for emergency cyst of size 18-
laparotomy in view of 20 cm.
 smooth surface fear of above
and contain stated
mucinous fluid. complications
They comprise while others
12%-15% of all recommend
ovarian tumors. conservative
Around 75% of all management
mucinous tumors because most of
are benign, while the cysts found
10% are borderline during pregnancy
and 15% are are corpus luteal
invasive cysts and they
carcinomas. The regress
benign mucinous spontaneously by
tumors are most 16 weeks of
Figure 2: Peroperatively common in the gestation.11
gross morphology was: third to fifth Ovarian torsions
Pedunculated right decades of life and therefore occur
sided massive ovarian may be 20-30 9
cm most commonly
cyst of size 18-20 cm in size. Giant during first
approximately with cysts are found in trimester, less
presence of twist with less than 1% of the commonly during
varigated consistency cases of ovarian second trimester
and punctate cysts with and rarely during
haemorrhages. pregnancy.10 third trimester.12
Torsion is the most
DISCUSSION common and Management:
serious
Frequency of ovariancomplication of Management of
tumours being coexistent benign ovarian ovarian cysts
cysts during depends on the
with pregnancy is 1:10007pregnancy. The
and among theseother size of cysts. Most
frequencies of beingcomplications of the cysts having
malignant iswhich might occur diameter of less
approximately 1:15000 toare rupture of cyst, than 6 cm and
1:32000 pregnancies.8infection, which have benign
Most common ovarianmalignancy, looking picture on
masses encounteredimpaction of cyst ultrasonography
during pregnancy arein pelvis, (USG) can be
functional cysts of ovary.obstructed labour managed
The other ovarian massesand conservatively and
in order are benign cysticmalpresentations careful follow up
teratomas, serous cystof can be done as
fetus.6 On
adenomas, paraovarianreview of literature most of them
cysts, mucinousthe studies are resolve
cystadenomas andlacking to guide spontaneously
endometriomas. 4
Theproper over time. Cysts
mucinous cystadenomasmanagement of which measure
are one of the benignsuch cases. Some more than 10cm
epithelial ovarian tumoursstudies favor are generally
which tend to be unilateralsurgical resected due to
and multilocular withintervention for fear of
Internation Reproducti ion, Obstetrics and
al Journal on, Gynecology Volume 4
of Contracept Issue 3 Page 916
Dahiya P et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):915-917
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