OC258: Ovarian cysts in young women?the predictive value of ultrasound for dermoids and endometriomas and managing cysts in early pregnancy

Adnexal cysts are common incidental findings in women of a reproductive age. 7% of asymptomatic premenopausal women have cysts > 25 mm. The vast majority are functional and an interval scan at 6 weeks demonstrates resolution. Endometriomas and dermoids account for over 2/3 of persistent cysts in premenopausal women. The predictive value of transvaginal sonography (TVS) has been evaluated in many studies. The predictive value of TVS in the detection of endometriomas and dermoids is 96.4% and 97.1% respectively—with false positive rates of 3.8% and 3.0% respectively. The incidence of adnexal pathology detected in the first trimester varies from 0.17%–2.94%. In a study of some 2245 women scanned at the end of the first trimester, 1.2% of the total persisted beyond 16 weeks and subsequently were surgically removed—there were no cases of malignancy. In a study of 55,278 pregnancy terminations, there were 2 cases of malignancy. We have prospectively evaluated 3000 consecutive women who presented to the Early Pregnancy Unit. The prevalence of ovarian cysts was 5.3%. These women were managed expectantly and followed until resolution of the ovarian cyst occurred, intervention was required or the pregnancy concluded. 72.2% resolved spontaneously, 23.6% persisted and 4.2% required intervention—there were no cases of malignancy. Only 0.13% (1.3/1000) of all women in this longitudinal study required acute intervention. We concluded that examining the ovaries in the first trimester is of no value. Expectant management is advocated, at least until the pregnancy is beyond 14 weeks' gestation. If symptomatic, simple ovarian cysts diagnosed during pregnancy can be successfully and safely treated with sonographic guided cyst aspiration. Adnexal masses can be accurately classified according to TVS. However in the few cases when the nature of the cyst is in question, one must balance the risks to the pregnancy from intervention versus the risk of malignancy.