Pregnancy with Ovarian Mass: A Varied Presentation

Abstract

Objective: Pregnancy with an ovarian mass of 6 cm is a rare condition that sometimes goes unnoticed until term and, at times, leads to an acute surgical emergency. Torsion, rupture, fetal malpresentation, and obstructed labor are main associated complications. Materials and methods: This was a retrospective study of 14 cases of ovarian masses during pregnancy. All cases with persistent ovarian mass of 6 cm with pregnancy, presented symptomatically or asymptomatically, were included in the study. Patients' medical records were analyzed for general profiles, gestation age, clinical presentation, signs and symptoms, investigation, management, and neonatal outcome. Results: Mean age and parity in the study were 23.92 ± 3.91 and 2.14 ± 2.14 respectively. Only 35.71% were symptomatic, 11 (78.57%) patients were diagnosed with ultrasonography, and in 3 (21.43%), the diagnosis was made incidentally during lower segment cesarean section (LSCS). Patients were managed according to gestation age, presenting symptoms, and nature of mass. Cystectomy was done in 8 (57.14%) patients followed by salpingo-oophorectomy in 4 (28.57%) cases, and detorsion and cystectomy in 2 (14.28%) cases. On histopathology, serous cystadenoma was the most common type (42.85%) followed by dermoid cyst (28.75%), dysgerminoma (7.14%), and mucinous cystadenoma (7.14%). However, two cases could not be assessed due to gangrenous changes of masses. Emergency surgery was required in five cases of torsion; rest of the patients were taken for elective surgery. Conclusion: Pregnancy is a unique clinical stage with many physiological changes for the mother with her fetus in the womb. It is the maternofetal well-being that is of paramount importance in managing varied presentations of an ovarian mass in pregnancy.