Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 16 , ISSUE S3 ( December, 2024 ) > List of Articles

REVIEW ARTICLE

Ovarian Cysts and Pregnancy: What is New? A Literature Review

Mohsen MA Abdelhafez, Karim AM Ahmed, Mohd NM Daud, Mohamad S Jeffree, Aya AM Eldiastey, Mohd F Bolong, Win W Than, Fairrul MA Kadir, DG Marshitah PG Baharuddin, Mohd F Hayati, Nornatherah Azizan, Doreen Sumpat, Syed SS AbdulRahim, Mohd F Amri, Mohd Y Ibrahim, Zhen Z Lo, Zainul A Zakaria, May Z Soe

Keywords : Adnexal masses, Laparoscopy, Laparotomy, Ovarian cysts, Pregnancy, Prenatal scans

Citation Information :

DOI: 10.5005/jp-journals-10006-2549

License: CC BY-NC 4.0

Published Online: 03-02-2025

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Ovarian cysts with pregnancy constitute a dilemma and challenge in both diagnosis and treatment. This review aims to synthesize, analyze, and accumulate data from published research, particularly the more recent ones, describing the evolving practices in the past 10 years for managing ovarian masses complicating pregnancy. This is a result of the continuous discussion and conundrum surrounding the best course of action for treating adnexal masses in gestation. The frequency of these masses being detected has risen over the past 20 years due to more usage of sonography for pregnancy monitoring. This has also led to technological advancements in screening equipment and a delay in childbearing till later in life. Assembled data from published research, particularly the more recent ones, demonstrating the methods of treating ovarian cysts in pregnancy, have changed over the past 10 years. Most ovarian cysts that form during pregnancy are benign, most likely functional, and have the potential to disappear on their own. Thankfully, most of these tumors are discovered unintentionally during a normal ultrasound scan performed during the initial prenatal visit during the first trimester of pregnancy. Ultrasound is the first choice and recommended diagnostic modality for the preliminary finding and monitoring of ovarian cysts whether in or following pregnancy. When ultrasonography (US) imaging is inconclusive, magnetic resonance imaging (MRI) and computed tomography (CT) scans can be helpful supplements. Conservative, surgical, or ultrasound-guided aspiration of big cysts are all possible treatment options for ovarian cysts during pregnancy.


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  1. Gasim T, Al Dakhiel SA, Al Ghamdi AA, et al. Ovarian tumors associated with pregnancy: A 20-year experience in a teaching hospital. Arch Gynecol Obstet 2010;282(5):529–533. DOI: 10.1007/s00404-009-1346-z.
  2. DePriest PD, DeSimone CP. Ultrasound screening for the early diagnosis of ovarian cancer. J Clin Oncol 2003;21(10 Suppl). DOI: 10.1200/JCO.2003.02.054.
  3. Hoover K, Jenkins TR. Evaluation and management of the adnexal mass throughout pregnancy. Am J Obstet Gynecol 2011;205(2): 97–102. DOI: 10.1016/J.AJOG.2011.01.050.
  4. Yazbek J, Salim R, Woelfer B, et al. The value of ultrasound visualization of the ovaries during the routine 11–14 weeks nuchal translucency scan. Eur J Obstet Gynecol Reprod Biol 2007;132(2):154–158. DOI: 10.1016/J.EJOGRB.2006.07.013.
  5. Amant F, Berveiller P, Boere IA, et al. Gynecologic malignancies in pregnancy: Guidelines based on a third international consensus meeting. Ann Oncol 2019;30(10):1601–1612. DOI: 10.1093/ANNONC/MDZ228.
  6. Timmerman D, Testa AC, Bourne T, et al. A multicenter study by the International Ovarian Tumor Analysis Group using a logistic regression model to distinguish between benign and malignant adnexal masses before surgery. J Clin Oncol 2005;23(34):8794–8801. DOI: 10.1200/JCO.2005.01.7632.
  7. Ronzoni S, Alberico D, Candiani M, et al. Fetal-maternal blood flow indices following laparoscopic surgery for pregnancy-related adnexal masses. J Minim Invasive Gynecol 2012;19(4):443–447. DOI: 10.1016/J.JMIG.2012.03.008.
  8. Bhagat N, Gajjar K. Management of ovarian cysts during pregnancy. Obstetrics, Gynaecology & Reproductive Medicine 2022;32(9): 205–210.
  9. Alalade AO, Maraj H. Management of adnexal masses in pregnancy. Obstetrician & Gynaecologist 2017;19(4):317–325. DOI: 10.1111/tog.12417.
  10. Schmeler KM, Mayo-Smith WW, Peipert JF, et al. Adnexal masses in pregnancy: Surgery compared with observation. Obstet Gynecol 2005;105(5 Pt 1):1098–1103. DOI: 10.1097/01.AOG.0000157465.99 639.E5.
  11. Whitecar P, Turner S, Higby K. A study by P. Whitecar, S. Turner, and K. Higby reviewed 130 cases of adnexal masses in pregnancy that underwent surgery. Am J Obstet Gynecol 1999;181(1):19–24. DOI: 10.1016/S0002-9378(99)70429-1.
  12. Kumari I, Kaur S, Mohan H, et al. Adnexal masses in pregnancy: A 5-year review. Aust N Z J Obstet Gynaecol 2006;46(1):52–54. DOI: 10.1111/j.1479-828X.2006.00515.x.
  13. El-Shawarby SA, Henderson AF, Mossa MA. Ovarian cysts during pregnancy: Dilemmas in diagnosis and management. J Obstet Gynaecol 2005;25(7):669–675. DOI: 10.1080/01443610500291686.
  14. Knudsen UB, Tabor A, Mosgaard B, et al. Management of ovarian cysts. J Obstet Gynecol Scand 2004;83(11):1012–1021. DOI: 10.1111/J.0001-6349.2004.00607.X.
  15. Bignardi T, Condous G. Management of ovarian disease during pregnancy. Best Pract Res Clin Obstet Gynaecol 2009;23(4):539–548. DOI: 10.1016/J.BPOBGYN.2009.01.009.
  16. Zanetta G. A prospective study on the management of adnexal masses during pregnancy with ultrasound. BJOG. 2003. DOI: 10.1016/s1470-0328(03)02940-9.
  17. Timmerman D, Testa AC, Bourne T, et al. Simple ultrasound-based guidelines for ovarian cancer diagnosis. Ultrasound Obstet Gynecol 2008;31(6):681–690. DOI: 10.1002/UOG.5365.
  18. Hidalgo JJ, Ros F, Auba M, et al. Retrospective assessment of alternative two-step strategy using simple-rules risk and prospective external validation of IOTA three-step strategy for characterizing and classifying adnexal masses. Ultrasound Obstet Gynecol 2019;53(5):693–700. DOI: 10.1002/uog.20163.
  19. Timor-Tritsch IE, Lerner JP, Monteagudo A, et al. Transvaginal ultrasonographic characterization of ovarian masses by means of color flow-directed Doppler measurements and a morphologic scoring system. Am J Obstet Gynecol 1993;168(3 Pt 1):909–913. DOI: 10.1016/S0002-9378(12)90843-1.
  20. Glanc P, Salem S, Farine D. Adnexal masses in the pregnant patient: A diagnostic and management challenge. Ultrasound Q. 2008;24(4):225–240. DOI: 10.1097/RUQ.0B013E31819032F.
  21. Guidelines Committee of the Society of American Gastrointestinal and Endoscopic Surgeons; Yumi H. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 2008;22(4):849–861. DOI: 10.1007/S00464-008-9758-6.
  22. Giuntoli RL, Vang RS, Bristow RE. Evaluation and management of adnexal masses during pregnancy. Clin Obstet Gynecol 2006;49(3):492–505. DOI: 10.1097/00003081-200609000-00009.
  23. Cannistra SA. Ovary Cancer. [Online]. Available at: www.nejm.org.
  24. Moore RG, Brown AK, Miller MC, et al. The use of multiple novel tumor biomarkers for the detection of ovarian carcinoma in patients with a pelvic mass. Gynecol Oncol 2008;108(2):402–408. DOI: 10.1016/J.YGYNO.2007.10.017.
  25. Bon GG, Kenemans P, Verstraeten AA, et al. Maternal serum Ca125 and Ca15-3 antigen levels in normal and pathological pregnancy. Fetal Diagn Ther 2001;16(3):166–172. DOI: 10.1159/000053903.
  26. Kobayashi F, Sagawa N, Nakamura K, et al. Mechanism and clinical importance of elevated CA 125 levels in the sera of pregnant women. Am J Obstet Gynecol 1989;160(3):563–566. DOI: 10.1016/S0002-9378(89)80027-4.
  27. Spencer CP, Robarts PJ. Management of adnexal masses in pregnancy. Obstetrician & Gynecologist 2006;8(1):14–19. DOI: 10.1576/toag.8.1.014.27203.
  28. Galgano MT, Hampton GM, Frierson HF. Comprehensive analysis of HE4 expression in normal and malignant human tissues. Mod Pathol 2006;19(6):847–853. DOI: 10.1038/MODPATHOL.3800612.
  29. Moore RG, Miller MC, Eklund EE, et al. Serum levels of the ovarian cancer biomarker HE4 are decreased during pregnancy and increase with age. Am J Obstet Gynecol 2012;206(4):349.e1–349.e7. DOI: 10.1016/J.AJOG.2011.12.032.
  30. Bast RC, Klug TL, St John E, et al. A radioimmunoassay using monoclonal antibody OC 125 for monitoring the course of epithelial ovarian cancer. N Engl J Med 1983;309(15):883–887. DOI: 10.1056/NEJM198310133091503.
  31. Pitta X, et al. Management of ovarian cysts and cancer in pregnancy. Ann N Y Acad Sci 2008;1138:284–287. DOI: 10.1196/ANALS.1414.034.
  32. Amant F, et al. Cancer in pregnancy: The mother of all challenges. Int J Gynecol Cancer 2008;18(4):591–596. DOI: 10.1111/J.1525-1438.2007.01115.X.
  33. Koonings PP, Campbell K, Mishell DR, et al. Relative frequency of primary ovarian neoplasms: A 10-year review. Obstet Gynecol 1989;74(6):921–926. DOI: 10.1097/00006250-198912000-00005.
  34. Shah P, et al. Gynecologic cancers in pregnancy. Obstet Gynecol 2009;114(1):125–129. DOI: 10.1097/AOG.0B013E3181AB71A6.
  35. Goff BA. Ovarian cancer: Screening and early detection. Obstet Gynecol Clin North Am 2012;39(1):183–194. DOI: 10.1016/J.OGC.2012.01.005.
  36. Chorlton I, et al. Adnexal masses and pregnancy: A retrospective study of 66 cases. Aust N Z J Obstet Gynaecol 2012;52(1):79–84. DOI: 10.1111/j.1479-828X.2011.01389.x.
  37. Rolf RT, et al. Conservative treatment of benign ovarian cysts in pregnancy: Clinical aspects and perinatal outcome. Arch Gynecol Obstet 2009;280(3):445–450. DOI: 10.1007/S00404-009-0956-4.
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