Ovarian cyst pregnancy is a volumetric neoplasm in the form of a cavity with liquid contents, which may exist before fertilization or form after conception of a child. With a small size of cysts, an asymptomatic course is possible, as the fetus grows, pains in the suprapubic region of varying intensity appear, radiating into the groin or sacrum, urination disorders, constipation. For diagnosis, ultrasound of the pelvic organs is used, which is supplemented with color Doppler mapping. Conservative therapy is aimed at preserving pregnancy and relieving the condition. Cysts are removed after the placenta matures.
D27 Benign ovarian neoplasm
Ovarian cyst is more often detected in patients of late reproductive age, usually exists even before conception, due to hormonal and immune changes during gestation, it increases in volume. Cystic formations are diagnosed in 0.02-0.46% of women carrying a child. The direct dependence of the appearance of cysts on pregnancy has not been established. In adolescents and patients over 45 years of age, there is a risk of malignancy of the neoplasm under the influence of endocrine factors.
The exact causes of the appearance of cysts in the ovaries during pregnancy are unknown. The most popular theory assumes the influence of endocrine disorders, which can be provoked by external or internal factors or a combination of them. The development of the disease is promoted by:
- Sexual infections. Chronic inflammatory diseases of the ovaries can cause a violation of the processes of proliferation in the tissues of organs. During pregnancy, the immune system weakens, the infection enters the active phase, which provokes the growth of a cyst.
- Hormonal changes. They are associated with a weakening of estrogen production and an increase in the stimulating effect of FSH. They cause diffuse, and then focal hyperplasia and proliferation of ovarian cells.
- Abortions. Termination of pregnancy causes fluctuations in the endocrine status, increases the risk of infection of the genitals. This leads to a violation of the hormonal regulation of the sex glands and proliferative processes.
- Heredity. The probability of developing the disease is increased in women who had cases of ovarian cysts on the maternal side.
- Prolonged absence of pregnancy. Regular ovulation is considered a damaging factor for ovarian tissues. If the patient does not get pregnant and does not take oral contraceptives that inhibit the work of the ovaries and the maturation of follicles, the risk of cyst formation increases.
The development of ovarian cysts often begins before pregnancy. Violation of neuroendocrine regulation leads to a weakening of the function of the sex glands. The stimulating effect of FSH triggers the processes of proliferation. The source of focal hyperplasia may be normal cells forming ovarian tissues, or the remains of embryonic rudiments. In the latter case, cysts appear, prone to malignancy.
With regular ovulation, the ovarian tissues are damaged at the moment of rupture of the follicle. The spilled liquid contains a large amount of estrogens, which enhance cell proliferation. In older women, along with conventional estrogens, altered phenolsteroids appear that can cause cyst malignancy, therefore malignant tumors are often diagnosed in pregnant women of pre-menopausal age.
Ovarian cysts found during pregnancy may also be a consequence of endometriosis. The pathogenesis of endometrioid cysts is associated with retrograde discharge of menstrual blood or with remnants of embryonic tissue in the genital glands. Under the influence of hormonal fluctuations, the epithelium in the cyst cavity is rejected, but does not go beyond the capsule and forms its contents.
Ovarian cysts during pregnancy are classified by histological structure, less often by the mechanism of origin. The division into types is the same as for neoplasms that have arisen outside the gestation period. Histological classification includes:
- Epithelial. Serous, endometrioid, light-cell and mixed cysts, Brenner’s tumor.
- From the stroma of the genital cord. Tecoma, fibroma.
- Germinogenic. Dermoid cyst, chorionepitheliomas and ovarian struma.
- Tumor-like processes. Endometriosis, luteoma of pregnancy, superficial epithelial and paraovarial cysts, polycystic, hyperthecosis.
Clinical manifestations do not depend on the histological structure of the ovarian cyst during pregnancy. At an early stage, there are no signs of the disease, the duration of the asymptomatic course can reach several years. Subsequently, aching dull pains in the lower abdomen periodically bother, which can radiate into the groin, perineum, lumbosacral region. Sometimes, before conception, patients do not know about the existence of a neoplasm, the diagnosis is made during registration and routine examination.
For the first trimester, the progression of symptoms is uncharacteristic. From 12-13 weeks, the uterus increases in size, changes the location of appendages, can squeeze the cyst and cause tension of its capsule. Pain in the lower abdomen increases, especially when the body position changes. Acute pain indicates the development of a complication – twisting of the leg of the ovarian cyst.
Ovarian cyst in 18% of cases causes termination of pregnancy at a short period, the probability of complications is determined by the hormonal activity of the neoplasm and the existing risk factors for spontaneous miscarriage. In 12% of pregnant women, serous or dermoid cysts twist at the base. The twist is accompanied by compression of the vessels feeding the tumor and tissue necrosis. Emergency care and hospitalization in the gynecological department are required.
In the 2-3 trimester, with neoplasms of a significant size, the fetus occupies an incorrect position – oblique or transverse, which makes it difficult to deliver through the natural birth canal and becomes an indication for cesarean section. If the patient gives birth on her own, at the end of the 1st period of labor, when attempts appear, there is a possibility of rupture of the cyst capsule and the attachment of the acute abdominal clinic.
Large and sedentary cystic formations can interfere with the advancement of the fetal head, therefore, the preservation of the tumor before delivery increases the risk of labor anomalies and injuries in the newborn. Malignant degeneration of the ovarian cyst during pregnancy occurs in 25% of women with this pathology.
Suspicion of an ovarian cyst may occur during examination or routine examination of a pregnant woman. The diagnosis is made in cooperation with an oncologist or oncologist, who exclude the malignant nature of the tumor. The following diagnostic methods are used:
- Gynecological examination. In a bimanual study over the Douglas space, a mobile tight-elastic formation is determined. The shape of a benign cyst is rounded or oval, the surface is smooth.
- Gynecological ultrasound. A benign ovarian cyst during pregnancy looks like a smooth-walled single-chamber formation of a rounded shape with smooth contours. The contents are hypoechoic or anechoic.
- CDG. Ovarian cyst is characterized by blood flow in single vessels located in the capsule. A large number of vessels of convoluted and irregular shape testifies in favor of malignancy.
- CA-125, CA 19-9. Cancer markers are determined for differential diagnosis with a malignant tumor. The analysis is highly specific, with an increase of more than 35 iU/ ml, 78-100% of pregnant women are diagnosed with ovarian cancer.
If an ovarian cyst is detected at the stage of conception planning, surgical treatment before pregnancy is recommended. In other cases, the tactics depend on the type of neoplasia. With follicular and luteal cysts, treatment is not always required, since in most women the formations disappear on their own within 2-3 cycles. With other types of cysts, hormone therapy is used at the initial stage, with ineffectiveness – laparoscopic removal.
Treatment of ovarian cysts in early pregnancy is carried out in conservative ways, aimed at preserving the fetus and reducing unpleasant symptoms. A complete cure by medical methods is impossible. Hospitalization in the department of gynecology is necessary in the first trimester when there is a threat of termination of gestation. From the second trimester, women are sent to the department of pathology of pregnant women. The following groups of drugs are used:
- Gestagens. Tableted progesterone for oral or vaginal administration is indicated to maintain the function of the corpus luteum and preserve pregnancy.
- Antispasmodics. They are prescribed to reduce the tone of the myometrium. Pregnant women are allowed to take medicines based on drotaverine or papaverine in the form of tablets, rectal candles or injections.
- β-blockers. They are used to reduce the tone of the uterus after 24 weeks. In the early stages, they are ineffective due to the lack of appropriate receptors.
In most patients, cysts with a diameter of up to 10 cm accidentally detected in the 1st trimester are luteal and regress independently after the final formation of the placenta. For other tumors, surgery is indicated. If the ovarian cyst at the beginning of pregnancy proceeds without complications, the intervention is refrained from until 16 weeks of gestation. With elevated cancer markers, surgical treatment is carried out as early as possible.
Laparoscopic access is used, which reduces the risk of complications and shortens the rehabilitation period. When performing surgery at a late date, laparotomy is performed. The volume of intervention is determined intraoperatively by the results of an urgent histological examination, ranging from cyst removal to ovarian resection. In severe cases, ovariectomy is performed, which does not affect the bearing of the fetus.
Prognosis and prevention
The prognosis of ovarian cysts during pregnancy is usually favorable. Timely removal of the neoplasm allows you to carry a child and give birth in due time. Reproductive function does not suffer, there are no contraindications for subsequent pregnancies. In order not to increase the risk of complications during gestation, cystic formations should be treated at the stage of conception planning.
Specific prevention of the disease has not been developed. Unprotected sex should be abandoned, timely treatment of inflammatory diseases of the genitals should be carried out, and abortions should be avoided. Patients who do not plan pregnancy and do not have contraindications to hormone therapy are recommended to use oral contraceptives to prevent hyperplastic processes of the reproductive organs.