Pregnancy and ovarian tumors

Ovarian tumors occur in 0.1-1.5% of pregnant women. Their structure is different: cysts, actual ovarian tumors, ovarian cancer. It is extremely difficult to determine the onset of ovarian neoplasm formation, since clinical manifestations are most often not expressed, if there is no pain when the cyst is shifted or the cyst stalk is twisted.

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Symptoms of ovarian tumors during pregnancy

Due to the lack of clinical manifestations, ovarian neoplasms in the second trimester of pregnancy are detected by bimanual vaginal-abdominal examination. In later stages of pregnancy, they can be detected by abdominal palpation or vaginal examination. Most often, tumors of different sizes and consistencies are detected on the side of the uterus; if they are located behind the uterus, difficulties in making a diagnosis arise. A valuable additional method for diagnosing ovarian neoplasms is ultrasound.

When the cyst stalk is twisted or the cyst capsule ruptures, symptoms of acute abdomen appear: pain, nausea, vomiting, tachycardia, coated tongue, pain on palpation, symptoms of peritoneal irritation.

If a cyst is detected during pregnancy and in the absence of clinical signs of acute abdomen, the cyst should not be removed until 16-18 weeks of pregnancy, since this is a persistent corpus luteum of pregnancy (with surgical intervention, pregnancy may be interrupted due to progesterone deficiency). After 16-18 weeks of pregnancy, the placenta should take over the function of the persistent corpus luteum of pregnancy, and then the cyst on the ovary may disappear on its own. This requires dynamic ultrasound monitoring. If clinical symptoms of acute abdomen appear, an operation is performed and the cyst is removed with subsequent histological examination. In the postoperative period, therapy is carried out aimed at preserving the pregnancy. During surgery, both laparotomic and laparoscopic access can be used.

Management of labor in ovarian tumors

The management of labor depends on whether the tumor interferes with the birth of the child. If the tumor interferes with labor, then a cesarean section is performed and the altered uterine appendages are removed, and healthy appendages are carefully examined during the operation.

Usually, ovarian neoplasms do not create obstacles for the passage of the fetus through the birth canal and the birth ends successfully. And only in the postpartum period, depending on the nature of the clinical picture, the issue of the scope of surgical intervention is decided.

The detection of ovarian cancer is an indication for surgery regardless of the gestational age. At the first stage, the altered ovaries and omentum can be removed. When the fetus is viable, a cesarean section and extirpation of the uterus with appendages, resection of the omentum are performed, and then chemotherapy is administered.

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