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  • Q&A with Australian Health Practitioners

    I am in the third trimester of pregnancy. Can I do surgery to remove ovary cyst?

    I'm 28 weeks pregnant at the moment. During week 7 the ultrasound found a large 78mm cyst on left ovary. Last month's vaginal ultrasound showed that the cyst has grown up to 84mm and inside has a solid 39mm cyst with vascularity. My doctor asked me to do a surgery to remove the ovary, but it has 10-20% risk of causing premature labour, so I prefer to wait bit longer. When I expressed my concern to the doctor, he said that it may burst, which is even worse. I did another ultrasound yesterday - the cyst didn't grow & I couldn't see blood supply to the solid mass this time. A different doctor told me that I can wait for another month. Can I have some opinion about my case? Is it urgent and requires a surgery now? How easy it is for the cyst to burst?
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    Dr Joseph Jabbour

    Gynaecologist, Gynaecologist - Infertility (IVF) Specialist, Obstetrician

    Dr Joseph Jabbour is a specialist Obstetrician & Gynaecologist and Fertility Specialist with Monash IVF situated in Sunnybank (Brisbane Southside). Dr Jabbour has had the … View Profile

    Hi there,

    I understand this is frustrating for you and I hope my answer can shed some light on your problem.

    Up to 2% of pregnancies are complicated with ovarian masses, and about 1-6%% of these cysts are malignant. The risk of malignancy is the major concern. The general consensus is to wait until the early second trimester prior to assessing whether surgery is required as the majority of these cysts disappear spontaneously. If the cyst is >10 cm in size or it is solid or has solid components, most gynaecologists would recommend surgical resection. The size > 10 cm predisposes the ovary to torsion and occlusion of blood supply which may lead to severe pain and loss of the ovary. The only way to diagnose a malignant cyst is by excising it and studying it under the microscope in the lab. Abnormal features on the scan may indicate an increased risk of malignancy (solid and cystic components with papillary areas and septae). Most ovarian cysts are benign such as dermoid, haemorrhagic, or endometriomas. These are relatively easy to diagnose on ultrasound scanning. These cysts can be conservatively managed until the baby is delivered. 

    If you operate on a cyst prior to 13 weeks gestation, the risk of miscarriage is about 10-15%. If you plan the surgery between 13 and 20 weeks the risk is substantially lower at 4%. Technically it is difficult to perform the surgery after 24 weeks without delivering the baby as the uterus is large and can mechanically obstruct the surgical field. 

    Some gynaecologists may perform blood tests looking at tumour markers. These markers are grossly elevated in certain types of malignant ovarian cysts. In case of unexplained elevations of these tumour markers, ovarian cancer should be considered and surgery discussed.

    Do not hesitate to obtain a second opinion from a sub-specialist gynaecology oncologist if you are still concerned. They can review the films, possibly organise an MRI scan and judge whether urgent surgery is warranted or not.

    At your current stage of pregnancy of 28 weeks, if you are asymptomatic and the cyst appears stable, I would do the tumour markers blood test. If the results return normal, you can monitor the cyst closely with regular U/S scans and aim to have it surgically excised once you deliver your baby. Your delivery may need to be expedited, possibly at around 32-34 weeks, especially if there is a solid and cystic component to the cyst. You would require steroid injections to help mature the baby's lungs. The delivery would probably need to be achieved via C-Section so the cyst can be managed concurrently. A sub-specialist gynaecology oncologist may need to be present at the time of the surgery. Once the baby is delivered, the doctors will examine the specimen at the time of the surgery and possibly send it off to the pathologist to examine under the microscope. A decision as to what type of surgery is required would depend on the results of the pathology. 

    Good luck with your decision and feel free to contact me if you have any further questions.

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