[Management of an ovarian cyst during pregnancy]

With routine ultrasonographic examination during the first trimester, the discovery of an ovarian cyst has become relatively common in the beginning of pregnancy. Between a waiting policy and interventionism, where is the optimal management situated? The objective of this article, based on the analysis of articles published on the subject in the data base of Medline, was to reply to this question.

Most of unilocular and anechoic ovarian cysts with thin borders during the first trimester are corpus luteum cysts. They are not generally present after the end of the first trimester. Except in the case of complications, abstention is advocated in their respect. After 16 weeks of amenorrhea, organic cysts are the most frequent, mainly dermoid cysts. Only ovarian cysts at risk of complication are to be considered. They are essentially ovarian cysts which, whatever their echogenic features, have a size > or =6 cm. Their prevalence is estimated between 0.5 and 2 per thousand of pregnancies. The complications of these cysts are represented mainly by torsion, intracystic bleeding and rupture.

Emergency surgery during the first trimester, especially before 9th week of amenorrhea, for complication of an ovarian cyst is associated with a high rate of abortion. In the second part of pregnancy, foetal morbidity with prematurity provoked by emergency surgery is considerable. The ideal period for scheduled surgery is probably the beginning of the second trimester. The probability of operating on a functional cyst becomes small and the rate of abortion is minimized. Coelioscopy is then often possible and does not appear to have much impact on the pregnancy. If we are sure of the organic character of an ovarian cyst, after 9 weeks of amenorrhea, then surgery is recommended.