Rajeswary Pillay1

AIM: Ovarian tumors of all types are identified in pregnancy in first trimester. This study focuses on the incidence, nature, symptoms, ultrasound and doppler detailing of ovarian masses identified by USS, and aims to understand what happens to the ovarian tumor and its effect on the pregnancy.

SETTINGS AND DESIGN: This was a prospective study where 5000 ladies consecutively attending antenatal outpatient clinic of Department of Obstetrics & Gynecology, Government Medical College, Kozhikode, Kerala (which is a tertiary health center) in their first trimester for registration were included, USS was done and those with ovarian cysts of size more than 3 cm were followed up in their subsequent visits. Those patients who needed surgery were evaluated for the indication, type of procedure done; any post-operative complications; histopathology was collected and analyzed. Non operated patients were examined either at caesarean or in postpartum period.

RESULTS: Of the 5000 patients who were included for study, 92 had ovarian tumors more than 3 cm in first USS in first trimester. Second USS done at 14 weeks to assess the tumor for persistence showed that of the 92 cases, 44(47.83%) ovarian cysts had regressed. Of the remaining 48 patients with persistent cysts 4 (8.33%) presented as acute torsion. 23 patients (47.91%) needed surgery for ovarian cysts- either laparoscopy or laparotomy. All patients tolerated surgery well. There were no pregnancy complications. Histopathology of resected tissue showed benign nature of ovarian cyst in all except for one report of borderline tumor. Conclusion-High incidence of asymptomatic ovarian tumors identified in early pregnancy due to widespread use of USS , about half will regress on its own; a few of them present as acute torsion needing emergency surgery. Some patients require surgical intervention in pregnancy due to mass abdomen or persistent pain abdomen. Both laparoscopy and laparotomy are well tolerated by these patients when done at 14-16 weeks of gestation. Most ovarian tumors are of benign nature.

Sample size: 5000 ladies registered in OP in consecutive manner.

Study Area: Tertiary health centre- Medical College, Kozhikode, Kerala.

Participants: 5000 ladies who attended the OP consecutively were evaluated and first trimester scan or pervaginal examination followed by USS was done. Ovarian cysts greater than 3 cm were included in this study.