VP61.12: Management of ovarian cysts coexisting with pregnancy at Kenyatta National Referral Hospital, Kenya

Asymptomatic adnexal masses are frequently diagnosed in pregnancy, either at the early booking scan or at the time of Caesarean section and are mostly ovarian in origin. The majority of ovarian cysts in pregnancy either resolve spontaneously or are due to benign conditions. Ovarian cancer is extremely rare in women of childbearing age and thus most of these cysts can be managed conservatively. If there is a suspicion of malignancy or there is a significant cyst complication, such as torsion, and surgery is planned, this should take place during the second trimester to minimize the risk of miscarriage. Management in pregnancy still remains a grey area and generally depends on symptomatology. We present a puzzling case of ovarian cysts coexisting in pregnancy and the dilemma of when to surgically intervene. We present a case of ovarian cysts coexisting with pregnancy. Our patient presented with complaints of right sided abdominal pains for two weeks at 28 weeks gestation by dates. She had earlier done an obstetric scan at 15 weeks gestation which had shown a right sided simple ovarian cyst. She was put on conservative management and was on pain management. She had 4 admissions into hospital due to intolerable pain and at 36 weeks gestation the pain was unbearable and an elective Caesarean section was done. A large right ovarian cyst was noted intraoperatively, dark coloured, twisted on its own stalk, measuring 8x9 cm and not bleeding. Right salpingoophorectomy was also done. Histology results of the mass showed luteinised hemorrhagic cyst consistent with torsion. She was discharged home on the third post-operative day stable. This particular case of ovarian cysts coexisting with pregnancy proved a challenge in the timing of the surgical intervention. The dilemma still remains on the exact time to intervene especially in the third trimester without compromising the fetal outcome.