Ovarian Cysts And Fibroids In Pregnancy


by Associate Prof. Dr. Eugene WK Leong.

MBBS ( Malaya ), MRCOG ( UK ), FRCOG ( UK ), MOG ( Malaya ).,

Fellowship Trained Gynae-Oncology and Minimally Invasive Surgery ( Kandang Kerbau Hospital, Singapore ).

University of Malaya Specialist Centre and University of Malaya.

How common are ovarian cysts in pregnancy?

The incidence of ovarian cysts in pregnancy is not common. Most cysts are not cancerous. The most common cysts are physiological or functional, and usually disappear spontaneously after the third or fourth month of pregnancy.


How do you know if the ovarian cysts are not cancerous?

If the cysts are small measuring  2cm or 3cm, clear in appearance, simple, do not contain papillary fronds or solid elements, they are usually not cancerous. Benign dermoid cysts can appear to have hair and solid elements and can be evaluated by an ultrasound scan. Tumour markers such as serum CA125 or serum alpha-fetoprotein are not accurate because they are naturally raised in pregnancy. If the cyst grows very rapidly then it is likely to be suspicious.


Which ovarian cysts need removal during pregnancy?

Most ovarian cysts are harmless and therefore do not need removal during pregnancy.  However, if the cyst is very big in size, there are suspicious features such as solid elements or papillary fronds inside the cyst, the cyst is growing rapidly and becoming painful, or if the cyst has thick capsuled, then removal may be necessary. Other indications signaling the need for removal include the presence of water in the abdomen (ascites), enlarged lymph nodes, accumulation of water in the lungs (pleural effusion) and enlargement of other organs like the liver and spleen.


If the cyst needs removal, when is the best time to do so?

Surgery in pregnancy has to be weighed very carefully.

Traditionally, any surgery during pregnancy is best done during the second trimester (13 to 28 weeks). Benefits must be weighed against the risk to the expecting mother and her baby.

The most important factor to consider is whether the cyst is cancerous or suspicious in nature. Surgery is usually done if the ovarian cyst is suspected to be cancerous. Cysts can sometimes be removed during an elective Caesarean section or after natural birth if the diagnosis is done close to the Expected Due Date (EDD).


What is a fibroid and should fibroids in pregnancy be a cause for concern?

A fibroid is a harmless, non-cancerous growth in the uterus which occurs more often in women who conceive late in life. A large fibroid situated at the lower part of the uterus may sometimes block the birth passage. This may pose some difficulty for the fetus’ head to descend and increase the possibility of a Caesarean birth.


Do you need to remove fibroids during pregnancy?

Fibroids are not cancerous and therefore do not need to be removed during pregnancy. Removal could be dangerous as the pregnant uterus is very vascular and can lead to profuse bleeding.


Should fibroids be removed after delivery?

Fibroids are very common amongst women during their fertile year, but are generally harmless and do not pose any symptoms, hence there is no need for removal. They grow larger in pregnancy and generally shrink back to their original size after delivery.  However, removal is necessary if the fibroid grows rapidly, or your menses gets too heavy, resulting in anaemia, or if the fibroid hinders pregnancy.


What is red degeneration of a fibroid?

Red degeneration of a fibroid is rare but can occur in pregnancy, usually during the second trimester. You may experience pain and tenderness at the fibroid site, and this can be accompanied by fever. Treatment is usually conservative: surgery is not a necessity and adequate painkillers is usually sufficient.

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