Pregnant .. and a dermoid cyst in left ovary. Surgery or not?
MS
and CT-scan) with an Ovarian Teratoma or dermoid cyst in my left
ovary. The size is around 8cm.
I had 3 episodes of SEVERE lower-left abdominal pain during the last
one month. The pain disappears automatically. In the first two
instants, after 15-30 minutes and in the last instant, after 3 hours.
My Gyn is giving me three options for the surgery to get it removed
1. Get it removed (midline incision) right now
2. If and when another episode of pain occurs
3. Get the baby delivered at 37 weeks through c-section and within the
same procedure, dermoid is also removed.
I am worried about the risk posed by General Anaesthesia to the baby
so nobody is completely sure about that.
Secondly, If I get the surgery done now, will my incision wound be
able to take the labour pain and contractions at the time of delivery?
If not, the docs may go for a cesarian section anyway.
What should I do?
Una
>I am 12 weeks pregnant and I have recently been diagnosed (through USG
>and CT-scan) with an Ovarian Teratoma or dermoid cyst in my left
>ovary. The size is around 8cm.
Hi MS. I am sorry you need us, but glad you found us. Most of us here
are parents or survivors of fetal teratomas, but some of us have experience
with teratomas and related germ cell tumors diagnosed later in life. I
don't know exactly who is reading this group these days, but maybe you'll
get some great feedback here.
I guess the first problem for you is to decide if your doctors are (and
can be) sure about the diagnosis. Most ovarian cysts are not tumors,
and normal (so called functional) cysts are more common during pregnancy.
There are medical papers on the problem of making a correct diagnosis:
PMID 18254309 and 16736136 (more info below).
>I had 3 episodes of SEVERE lower-left abdominal pain during the last
>one month. The pain disappears automatically. In the first two
>instants, after 15-30 minutes and in the last instant, after 3 hours.
Ovarian tumors usually are painless. When there is pain it tends to
be very persistent. Persistent severe pain suggests a torsion, which
is a medical emergency and requires prompt surgery. What you describe
sounds like round ligament pain, which is totally normal and happens
in late 1st trimester as the uterus grows. I don't know why it should
be so, but round ligament pain often occurs on just one side. Another
possibility is cramping of the large intestine, which descends in the
lower left quadrant. Pregnancy involves quite a lot of rearrangement
of your insides. (Is this your first pregnancy?) So the problem here
for you is to determine if the pain is due to the cyst, or unrelated!
If it is unrelated, then it should not be factored into your treatment
plans.
>My Gyn is giving me three options for the surgery to get it removed
>
>1. Get it removed (midline incision) right now
>2. If and when another episode of pain occurs
>3. Get the baby delivered at 37 weeks through c-section and within the
>same procedure, dermoid is also removed.
I would want a 4th option: deliver the baby when the baby is good and
ready, and then deal with the cyst. Your cyst is on the small side.
Once there is room to work and no pregnancy to worry about, the ovary
can be removed by open abdominal surgery (if they suspect malignancy
and need to check your lymph nodes for metastasis) or transvaginally.
There is a risk of miscarriage as a consequence of the surgery. And
even at 37 weeks, nominal full term, there is a risk that the baby
will not be ready.
Laparascopy was fashionable for a few years, for removing truly benign
ovarian tumors, but it almost always involves rupture of the tumor and
spill, and there have been cases of disseminated malignancy as a
result, so it is no longer popular. The problem is that, in the case
of germ cell tumors (including teratomas) it is difficult to tell if
the tumor is malignant in advance. So using laparascopy is taking a
risk. There is a very new laparascopic technique, involving gluing a
tube to the tumor capsule, rupturing the tumor into the tube with full
containment, then removing the tumor. It is cutting edge and sounds
wonderful, but may be technically difficult so you would have to go to
a surgeon with expertise there.
Which brings me to: malignancy. Have your doctors discussed with you
the chance that the tumor is malignant? Have they talked about how to
diagnose malignancy? Or how to treat it? There are some case reports
of successful chemotherapy during pregnancy. Have you had a MS AFP
test? See PMID 9205440 (below).
>I am worried about the risk posed by General Anaesthesia to the baby
>so nobody is completely sure about that.
For that, you should consult the anesthesiologist. Also, would the
anesthesia necessarily be general? A lot of abdominal surgeries,
including C sections, are done under epidural or spinal blocks. If
the anesthesiologist who would assist during your operation cannot
answer all your questions about relative risks of anesthesia in your
particular case, then I recommend you consider going to a different
hospital.
>Secondly, If I get the surgery done now, will my incision wound be
>able to take the labour pain and contractions at the time of delivery?
No problem there. Surgery to remove the cyst would involve your
abdominal wall but not touch your uterus, and you would have almost
6 months to heal. The abdominal wall is not involved in uterine
contractions and many pregnant women have a midline separation (a
diastasis recti, see http://en.wikipedia.org/wiki/Diastasis_recti)
late in pregnancy. It has no impact on labor and delivery.
>What should I do?
Exactly what you are doing: ask questions! Figure out what questions
you really need to ask, and get answers. Below are some MEDLINE
records of medical articles, including abstracts. Those are not the
articles themselves; if you don't have access to a medical library
and you are in the US, try using Interlibrary Loan through a local
public library. If you feel able to explain to the librarian that
you are researching your own medical care, you may get faster service.
If you are in the UK, I believe there is a government program through
the British Library to get you any medical articles you need.
Some questions for you to ask: do they propose to remove just the
cyst, or the whole ovary, or the ovary and fallopian tube too. Would
they have an interoperative pathology consult? *If* the cyst is a
teratoma, there is a small risk that it is malignant, in which case
you do *not* want it to be disturbed for a biopsy. That creates too
high a risk of spilling malignant cells into your abdominal cavity.
There may be some advantage to leaving the cyst alone until after the
pregnancy is over, but that depends very much on diagnostic details
you have not mentioned.
I hope this helps you focus your thoughts on the next steps to take.
If you haven't already had your MS AFP tested, I would make that a
high priority.
Una
PMID - 18254309
OWN - NLM
STAT - MEDLINE
DA - 20080207
DCOM - 20080404
PUBM - Print
IS - 0041-4131 (Print)
VI - 85
IP - 9
DP - 2007 Sep
TI - [Management of ovarian cyst associated to pregnancy]
PG - 773-6
AB - BACKGROUND: The problem of the association of the ovarian cyst and pregnancy is to determine whether the cyst is functional or organic? AIM: To draw up the epidemiological profile of the patients having a cyst of the ovary, show the peculiarities of this association; and to clarify the therapeutic methods and its effects on the progress of the pregnancy. METHODS: A retrospective study concerning a period of 5 years and interesting 25 patients. RESULTS: The average age of the patients was of 34 years, the average parity was of 2. The discovery of the cyst was in 68% of cases in the first 3 months. On the clinical plan the circumstances of discovery were pelvic pains in 48% of cases and complications in 6% of cases; such us twisting of the cyst. 61% of the patients had a laparoscopy, 44% a laparotomy and a case of guided ultrasound punction, 4% of the patients underwent a pregnancy interruption, 17 pregnancies were led till the end, we noted an intrauterine death of the foetus and a case of late abortion at 22SA. CONCLUSION: problems due to the association of the ovarian cyst and pregnancy are especially of diagnostic and therapeutic order. Obsession was to underestimate a malignant tumour; that's why we should perform a surgical investigation in front of any persevering cyst beyond the first three months of the pregnancy.
AD - Service C, Centre de Maternite et de Neonatalogie Tunis.
FAU - Ben Hmid, Rim
AU - Ben Hmid R
FAU - Mahjoub, Sami
AU - Mahjoub S
FAU - Mabrouk, Sonia
AU - Mabrouk S
FAU - Zeghal, Dorra
AU - Zeghal D
FAU - Mrad, Marwen
AU - Mrad M
FAU - Zouari, Faouzia
AU - Zouari F
LA - fre
PT - English Abstract
PT - Journal Article
TT - Prise en charge du kyste de l'ovaire et grossesse: a propos de 25 cas.
PL - Tunisia
TA - Tunis Med
JT - La Tunisie medicale
JID - 0413766
SB - IM
MH - Adult
MH - Female
MH - Humans
MH - *Ovarian Cysts/diagnosis/therapy
MH - Pregnancy
MH - *Pregnancy Complications, Neoplastic/diagnosis/therapy
MH - Retrospective Studies
EDAT - 2008/02/08 09:00
MHDA - 2008/04/05 09:00
PST - ppublish
SO - Tunis Med. 2007 Sep;85(9):773-6.
PMID - 16736136
OWN - NLM
STAT - MEDLINE
DA - 20061124
DCOM - 20070315
PUBM - Print-Electronic
IS - 0938-7994 (Print)
VI - 16
IP - 12
DP - 2006 Dec
TI - MR features of physiologic and benign conditions of the ovary.
PG - 2700-11
AB - In reproductive women, various physiologic conditions can cause morphologic changes of the ovary, resembling pathologic conditions. Benign ovarian diseases can also simulate malignancies. Magnetic resonance imaging (MRI) can play an important role in establishing accurate diagnosis. Functional cysts should not be confused with cystic neoplasms. Corpus luteum cysts typically have a thick wall and are occasionally hemorrhagic. Multicystic lesions that may mimic cystic neoplasms include hyperreactio luteinalis, ovarian hyperstimulation syndrome, and polycystic ovary syndrome. Recognition of clinical settings can help establish diagnosis. In endometrial cysts, MRI usually provides specific diagnosis; however, decidual change during pregnancy should not be confused with secondary neoplasm. Peritoneal inclusion cysts can be distinguished from cystic neoplasms by recognition of their characteristic configurations. Ovarian torsion and massive ovarian edema may mimic solid malignant tumors. Recognition of normal follicles and anatomic structures is useful in diagnosing these conditions. In pelvic inflammatory diseases, transfascial spread of the lesion should not be confused with invasive malignant tumors. Radiologic identification of abscess formation can be a diagnostic clue. Many benign tumors, including teratoma, Brenner tumor, and sex-cord stromal tumor, frequently show characteristic MRI features. Knowledge of MRI features of these conditions is essential in establishing accurate diagnosis and determining appropriate treatment.
AD - Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Kyoto, Japan. ta...@kuhp.kyoto-u.ac.jp
FAU - Tamai, Ken
AU - Tamai K
FAU - Koyama, Takashi
AU - Koyama T
FAU - Saga, Tsuneo
AU - Saga T
FAU - Kido, Aki
AU - Kido A
FAU - Kataoka, Masako
AU - Kataoka M
FAU - Umeoka, Shigeaki
AU - Umeoka S
FAU - Fujii, Shingo
AU - Fujii S
FAU - Togashi, Kaori
AU - Togashi K
LA - eng
PT - Journal Article
PT - Review
DEP - 20060531
PL - Germany
TA - Eur Radiol
JT - European radiology
JID - 9114774
SB - IM
MH - Diagnosis, Differential
MH - Female
MH - Humans
MH - Magnetic Resonance Imaging/*methods
MH - Ovarian Diseases/*diagnosis
MH - Ovary/*anatomy & histology
RF - 44
EDAT - 2006/06/01 09:00
MHDA - 2007/03/16 09:00
PHST - 2005/07/07 [received]
PHST - 2006/04/18 [accepted]
PHST - 2006/04/08 [revised]
PHST - 2006/05/31 [aheadofprint]
AID - 10.1007/s00330-006-0302-6 [doi]
PST - ppublish
SO - Eur Radiol. 2006 Dec;16(12):2700-11. Epub 2006 May 31.
PMID - 16122200
OWN - NLM
STAT - MEDLINE
DA - 20050826
DCOM - 20051207
PUBM - Print
IS - 0392-2936 (Print)
VI - 26
IP - 4
DP - 2005
TI - Teratomas of the ovary: a clinico-pathological evaluation of 87 patients from one institution during a 10-year period.
PG - 446-8
AB - AIM: To present the classification and diagnostic problems encountered between teratomas and other ovarian tumors as well as with other benign entities diagnosed and treated in our institution. METHODS: We analysed retrospectively the clinical and pathological characteristics of 87 teratomas examined in our hospital during the last ten years. RESULTS: Teratomas constituted 5% of all ovarian tumors. The age range was from 11-69 years old (median: 35). The most frequent symptom was lower abdominal pain in 68% of patients. A pelvic mass was noted in 3% of cases. A pregnancy was present in 3% of patients. In ten cases the tumors were bilateral. Tumor size ranged from 1-16 cm in diameter (median: 7.17 cm). The treatment consisted of cystectomy in 66% of the cases, oophorectomy in 23% or hysterectomy with both adnexa in 11% of cases. Fifty-seven cases presented with a histological diagnosis of mature teratoma, biphasic or triphasic type, three cases with monodermal teratoma, ten cases with ovarian neoplasms of mixed type, 15 cases with epidermal cysts, and two cases with benign cysts. Malignant changes within the teratomas were seen in 5% cases. CONCLUSION: Teratomas are common ovarian tumors at any age, especially during the reproductive age, with a low rate of complications and malignant transformation. The treatment should be based on patient age, fertility status, tumor size, the cystic or solid nature of the tumor and bilaterality.
AD - 2nd Clinic of Obstetrics and Gynecology, Areteion University Hospital, Athens Medical School, Athens, Greece.
FAU - Papadias, K
AU - Papadias K
FAU - Kairi-Vassilatou, E
AU - Kairi-Vassilatou E
FAU - Kontogiani-Katsaros, K
AU - Kontogiani-Katsaros K
FAU - Argeitis, J
AU - Argeitis J
FAU - Kondis-Pafitis, A
AU - Kondis-Pafitis A
FAU - Greatsas, G
AU - Greatsas G
LA - eng
PT - Journal Article
PL - Italy
TA - Eur J Gynaecol Oncol
JT - European journal of gynaecological oncology
JID - 8100357
SB - IM
MH - Adolescent
MH - Adult
MH - Aged
MH - Female
MH - Humans
MH - Middle Aged
MH - Ovarian Neoplasms/classification/*diagnosis
MH - Pregnancy
MH - Pregnancy Complications, Neoplastic/classification/*diagnosis
MH - Retrospective Studies
MH - Teratoma/classification/*diagnosis
EDAT - 2005/08/27 09:00
MHDA - 2005/12/13 09:00
PST - ppublish
SO - Eur J Gynaecol Oncol. 2005;26(4):446-8.
PMID - 11588812
OWN - NLM
STAT - MEDLINE
DA - 20011008
DCOM - 20011018
LR - 20061115
PUBM - Print
IS - 0300-9041 (Print)
VI - 69
DP - 2001 Jul
TI - [Germinal cancer of the ovary and pregnancy]
PG - 282-7
AB - The association of ovarian cancer with pregnancy, in a young patient with acute abdominal syndrome was reviewed. The prognosis is related to early diagnosis and the stage, therefore ultrasonography is the corner stone to detect these tumors allowing a conservative management, mainly when the fertility must be maintained in younger patients. Chemotherapy is an excellent adjuvant in the midtrimester and can be administered without an important deleterious effect on the fetus.
AD - Hospital General de Zona con Medicina Familiar No. 1, Instituto Mexicano del Seguro Social, Ciudad Victoria, Tamaulipas.
FAU - Novoa Vargas, A
AU - Novoa Vargas A
LA - spa
PT - Case Reports
PT - English Abstract
PT - Journal Article
TT - Cancer germinal de ovario y embarazo.
PL - Mexico
TA - Ginecol Obstet Mex
JT - Ginecologia y obstetricia de Mexico
JID - 0376552
SB - IM
MH - Adult
MH - *Dysgerminoma/diagnosis/pathology/therapy
MH - Female
MH - Humans
MH - *Ovarian Neoplasms/diagnosis/pathology/therapy
MH - Pregnancy
MH - *Pregnancy Complications, Neoplastic/diagnosis/pathology/therapy
MH - *Teratoma/diagnosis/pathology/therapy
EDAT - 2001/10/09 10:00
MHDA - 2001/10/19 10:01
PST - ppublish
SO - Ginecol Obstet Mex. 2001 Jul;69:282-7.
PMID - 10870321
OWN - NLM
STAT - MEDLINE
DA - 20000717
DCOM - 20000717
LR - 20041117
PUBM - Print
IS - 0929-6646 (Print)
VI - 99
IP - 4
DP - 2000 Apr
TI - Laparoscopic cystectomy of a twisted, benign, ovarian teratoma in the first trimester of pregnancy.
PG - 345-7
AB - Adnexal torsion is an unusual, but serious complication in pregnancy. The treatment is surgical, but this may increase the risk of pregnancy loss in the first trimester. The use of laparoscopic surgery, which is less invasive than traditional laparotomy, has been limited by diagnostic and technical difficulties including determination of ovarian tumor nature and spillage of cyst contents intraoperatively. A 25-year-old woman in her 11th week of pregnancy had acute severe left lower-abdominal pain, which was diagnosed as left ovarian teratoma with torsion. She underwent emergency laparoscopic surgery with unwinding of the twisted fallopian tube and ovary and cystectomy of the teratoma. The patient subsequently delivered a full-term baby, without complications. Accurate ultrasound and cytologic diagnoses along with copious intraoperative warm, normal saline irrigation were likely contributing factors to the successful outcome of this case.
AD - Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.
FAU - Yen, M L
AU - Yen ML
FAU - Chen, C A
AU - Chen CA
FAU - Huang, S C
AU - Huang SC
FAU - Hsieh, C Y
AU - Hsieh CY
LA - eng
PT - Case Reports
PT - Journal Article
PL - CHINA (REPUBLIC: 1949- )
TA - J Formos Med Assoc
JT - Journal of the Formosan Medical Association = Taiwan yi zhi
JID - 9214933
SB - IM
MH - Adult
MH - Female
MH - Humans
MH - Laparoscopy
MH - Ovarian Neoplasms/*surgery
MH - Pregnancy
MH - Pregnancy Complications, Neoplastic/*surgery
MH - Pregnancy Trimester, First
MH - Teratoma/*surgery
EDAT - 2000/06/28 11:00
MHDA - 2000/07/25 11:00
PST - ppublish
SO - J Formos Med Assoc. 2000 Apr;99(4):345-7.
PMID - 10767517
OWN - NLM
STAT - MEDLINE
DA - 20000627
DCOM - 20000627
LR - 20041117
PUBM - Print
IS - 0301-2115 (Print)
VI - 90
IP - 1
DP - 2000 May
TI - Malignant germ cell tumors of the ovary. Pregnancy considerations.
PG - 87-91
AB - OBJECTIVE: To study the pregnancy association and malignant germ cell tumors of the ovary with regard to its effects on tumor prognosis. STUDY DESIGN:: Seventy-five patients with malignant germ cell tumors of the ovary treated at the King Faisal Specialist Hospital-Research Center (KFSH-RC) Riyadh, Kingdom of Saudi Arabia between January 1976 and December 1992, were reviewed. Data was retrieved from the medical records and the database of ovarian tumor pathology. Patients with tumor/pregnancy association were identified and correlation with obstetrical outcome and tumor prognosis analyzed. Patients who conceived after treatment were identified and their reproductive outcome described. RESULTS: Malignant germ cell tumor was associated with pregnancy in a group of ten patients. Possible tumor effects upon pregnancy in this group included operative delivery by caesarean section (n=3), mid-trimester termination (n=2), spontaneous abortion (n=1). Four patients had normal vaginal birth with no apparent tumor effects upon pregnancy. Pregnancy did not seem to influence the tumor prognosis of pure dysgerminoma (n=6), however, two patients with non-dysgerminomatous germ cell tumor (one endodermal sinus tumor and one immature teratoma) died of rapidly progressive disease during the second trimester. Two patients with advanced (stage IIIC) disease concurrent with pregnancy (one pure dysgerminoma and one mixed germ cell tumor), had normal fetal outcomes and achieved long-term survival. Amongst the 22 patients who planned to conceive after conservative surgery, with or without post-operative adjuvant chemotherapy, 12 conceived (12/22) and achieved a total of 20 pregnancies. Their outcomes included normal births (n=18) including one set of twins and hydatidiform moles (n=2). CONCLUSIONS: Our findings suggest that, (1) The association of pure dysgerminoma and pregnancy did not adversely affect the tumor prognosis or fetal outcome. However, the question remains as to whether pregnancy worsened the prognosis of non-dysgerminomatous germ cell tumors. (2) Recent platinum-based regimens of multiagent chemotherapy for germ cell tumors did not seem to affect fertility potential.
AD - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, King Fahad National Guard Hospital, Riyadh, Saudi Arabia.
FAU - Bakri, Y N
AU - Bakri YN
FAU - Ezzat, A
AU - Ezzat A
AU - Akhtar
AU - Dohami
AU - Zahrani
LA - eng
PT - Journal Article
PL - IRELAND
TA - Eur J Obstet Gynecol Reprod Biol
JT - European journal of obstetrics, gynecology, and reproductive biology
JID - 0375672
SB - IM
MH - Adolescent
MH - Adult
MH - Female
MH - Germinoma/*pathology/therapy
MH - Humans
MH - Middle Aged
MH - Neoplasm Staging
MH - Ovarian Neoplasms/*pathology/therapy
MH - Pregnancy
MH - Pregnancy Complications, Neoplastic/*pathology/therapy
MH - Pregnancy Outcome
MH - Reproductive History
EDAT - 2000/04/18 09:00
MHDA - 2000/07/06 11:00
AID - S0301211599002134 [pii]
PST - ppublish
SO - Eur J Obstet Gynecol Reprod Biol. 2000 May;90(1):87-91.
PMID - 10690674
OWN - NLM
STAT - MEDLINE
DA - 20000310
DCOM - 20000310
LR - 20071115
PUBM - Print
IS - 0301-2115 (Print)
VI - 88
IP - 2
DP - 2000 Feb
TI - Mature cystic teratomas of the ovary: case series from one institution over 34 years.
PG - 153-7
AB - OBJECTIVE: To evaluate bilaterality, complications and malignant changes of mature cystic teratomas of the ovary. STUDY DESIGN: Retrospective study of 501 patients operated at Hacettepe University Hospital between the years of 1964 and 1998. RESULTS: The median age was 35 years (range 13-76). One hundred and six cases (21.1%) were asymptomatic. The mean tumor diameter was 7.0+/-4.5 cm. The decision for cystectomy or oophorectomy was related with the patient age, gravidity and parity. The bilaterality rate when both ovaries were evaluated histopathologically was 13.2% (44/331). Total complication rate was 10.7%, torsion being the most frequent (4.9%). The rate of malignant transformation was 1.4%. CONCLUSION: Ovarian mature cystic teratomas are common tumors especially during the reproductive period with low rates of covert bilaterality, complications and malignant transformation. The treatment should be directed on the basis of age, fertility desire or presence of another pelvic pathology rather than the size or bilaterality.
AD - Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey. buku...@hacettepe.edu.tr
FAU - Ayhan, A
AU - Ayhan A
FAU - Bukulmez, O
AU - Bukulmez O
FAU - Genc, C
AU - Genc C
FAU - Karamursel, B S
AU - Karamursel BS
FAU - Ayhan, A
AU - Ayhan A
LA - eng
PT - Journal Article
PL - IRELAND
TA - Eur J Obstet Gynecol Reprod Biol
JT - European journal of obstetrics, gynecology, and reproductive biology
JID - 0375672
SB - IM
MH - Adolescent
MH - Adult
MH - Aged
MH - Female
MH - Humans
MH - Hysterectomy
MH - Middle Aged
MH - Ovarian Neoplasms/complications/*pathology/surgery
MH - Ovariectomy
MH - Pregnancy
MH - Pregnancy Complications, Neoplastic
MH - Retrospective Studies
MH - Rupture, Spontaneous
MH - Teratoma/complications/*pathology/surgery
MH - Torsion Abnormality
EDAT - 2000/02/26 09:00
MHDA - 2000/03/18 09:00
AID - S0301211599001414 [pii]
PST - ppublish
SO - Eur J Obstet Gynecol Reprod Biol. 2000 Feb;88(2):153-7.
PMID - 9065118
OWN - NLM
STAT - MEDLINE
DA - 19970317
DCOM - 19970317
LR - 20041117
PUBM - Print
IS - 0002-9378 (Print)
VI - 174
IP - 5
DP - 1996 May
TI - Laparoscopic management of benign cystic teratomas during pregnancy.
PG - 1499-501
AB - OBJECTIVE: Our purpose was to evaluate the surgical management and outcome of laparoscopic removal of benign cystic teratomas during pregnancy. STUDY DESIGN: The records of women with benign cystic teratomas who were managed with operative laparoscopy during pregnancy were reviewed. RESULTS: Twelve women had laparoscopic removal of a benign cystic teratoma during pregnancy. Gestational ages at surgery ranged from 9 to 17 weeks, with a mean of 14 weeks. Cyst size ranged from 5 to 13 cm, with a mean of 8.5 cm. Intraoperative rupture of the cyst occurred in 10 of 12 (93%) women. No patient had evidence of chemical peritonitis. The mean operating time was 87 minutes and the mean postoperative hospital stay was 44 hours. No intraoperative or postoperative maternal or fetal complications occurred. CONCLUSIONS: Laparoscopic removal of a benign cystic teratoma of the ovary may be safely accomplished during pregnancy. In spite of a significant risk of cyst rupture, careful operative technique followed by copious irrigation of the pelvis may avoid chemical peritonitis and potential adverse sequelae.
AD - Department of Obstetrics and Gynecology, University of California, Los Angeles, School of Medicine, USA.
FAU - Parker, W H
AU - Parker WH
FAU - Childers, J M
AU - Childers JM
FAU - Canis, M
AU - Canis M
FAU - Phillips, D R
AU - Phillips DR
FAU - Topel, H
AU - Topel H
LA - eng
PT - Journal Article
PL - UNITED STATES
TA - Am J Obstet Gynecol
JT - American journal of obstetrics and gynecology
JID - 0370476
SB - AIM
SB - IM
MH - Adult
MH - Female
MH - Humans
MH - *Laparoscopy
MH - Ovarian Neoplasms/*surgery
MH - Pregnancy
MH - Pregnancy Complications, Neoplastic/*surgery
MH - Pregnancy Outcome
MH - Retrospective Studies
MH - Teratoma/*surgery
MH - Treatment Outcome
EDAT - 1996/05/01
MHDA - 1996/05/01 00:01
AID - S0002937896002542 [pii]
PST - ppublish
SO - Am J Obstet Gynecol. 1996 May;174(5):1499-501.
PMID - 9205440
OWN - NLM
STAT - MEDLINE
DA - 19970731
DCOM - 19970731
LR - 20041117
PUBM - Print
IS - 0029-7844 (Print)
VI - 84
IP - 4 Pt 2
DP - 1994 Oct
TI - Mixed germ cell malignancy of the ovary concurrent with pregnancy.
PG - 662-4
AB - BACKGROUND: A rare malignant germ cell tumor of the ovary during pregnancy was detected by screening of maternal serum alpha-fetoprotein (MSAFP). Treatment of this uncommon tumor during pregnancy incorporated combination chemotherapy including etoposide. CASE: An 18-year-old primiparous woman undergoing antenatal genetic screening was found to have an extremely elevated MSAFP of 477.8 IU/mL, or 12.46 multiples of the median. Oophorectomy and staging laparotomy at 20.5 weeks' gestation resulted in the diagnosis of mixed germ cell tumor of the ovary, with both endodermal sinus tumor and grade 3 immature teratoma. The patient received three courses of cis-platinum, etoposide, and bleomycin. Maternal serum AFP titers had returned to normal pregnancy levels by the start of the second course. A healthy female infant was delivered at 39 weeks' gestation following induction of labor for pregnancy-induced hypertension. CONCLUSION: Elevated MSAFP levels may be a presenting sign of malignant ovarian germ cell neoplasms. This report describes both surgical and chemotherapeutic treatment of a germ cell malignancy during pregnancy, with delivery at term. To date, major fetal toxicity from chemotherapy has not been identified.
AD - Department of Obstetrics and Gynecology, Pediatrics, and Family Medicine, University of Kansas School of Medicine-Wichita, USA.
FAU - Horbelt, D
AU - Horbelt D
FAU - Delmore, J
AU - Delmore J
FAU - Meisel, R
AU - Meisel R
FAU - Cho, S
AU - Cho S
FAU - Roberts, D
AU - Roberts D
FAU - Logan, D
AU - Logan D
LA - eng
PT - Case Reports
PT - Journal Article
PL - UNITED STATES
TA - Obstet Gynecol
JT - Obstetrics and gynecology
JID - 0401101
RN - 0 (alpha-Fetoproteins)
SB - AIM
SB - IM
MH - Adolescent
MH - Female
MH - *Germinoma/blood/diagnosis/drug therapy
MH - Humans
MH - *Ovarian Neoplasms/blood/diagnosis/drug therapy
MH - Pregnancy
MH - *Pregnancy Complications, Neoplastic/blood/diagnosis/drug therapy
MH - alpha-Fetoproteins/analysis
EDAT - 1994/10/01
MHDA - 1994/10/01 00:01
PST - ppublish
SO - Obstet Gynecol. 1994 Oct;84(4 Pt 2):662-4.
MS
Thanks for the eye-opener. I am glad I found you guys. I agree that
the correctness of diagnosis needs to be evaluated and malignancy
needs to be ruled out.
Answering some of your questions:
>(Is this your first pregnancy?)
>Have your doctors discussed with you the chance that the tumor is malignant? Have they talked about how to diagnose malignancy? Or how to treat it? There are some case reports of successful chemotherapy during pregnancy. Have you
had a MS AFP test?
can be called as rare. They have not talked about ruling it out
though. I have not been advised by my doc to have the MS AFP yet.
>Also, would the anesthesia necessarily be general?
midline incision they were planning to have but I am not sure. I will
ask this question again to my doc.
>do they propose to remove just the cyst, or the whole ovary, or the ovary and fallopian tube too.
abdomen. And in order to avoid spillage, they might decide to remove
the ovary (completely or partly)
Here are a few more questions that you or someone can answer:
I agree that MS AFP should be the next step. I will get it done as
soon as possible and will post the results here. Meanwhile, can you
tell me what would be the expected AFP value in the current week of
pregnance (My LMP is 13-May-2008)?
What should be the value if there is a malignancy? and if there is
none?
My USG report said: "An echogenic mass measuring 92x48x83mm in the
left lumber region extending towards and crossing midline. Acoustic
shadowing due to internal calcification also noted. On color doppler
no blood flow seen. Therefore a suspicion of Dermoid. A CT scan is
advised for confirmation"
My question is that is it enough information to suspect a dermoid?
Secondly, the CT scan report (by the same radiologist) confirmed "a
79x77x50mm well defined encapsulated mass in the left lower abdomen
quadrant. Small amount of calcification at the inferior aspect of
mass. Conclusion: Left ovarian teratoma"
Once again, does it necessarily indicate a left ovarian teratoma?
Couldn't it be Corpus luteum cyst? How can the two be differentiated?
Also you would have noticed a difference in the size in both the
reports. Is it within the normal margin of errors?
As you suggested, I am going to question as much as possible so I will
be asking all these questions to my Doctor and will post her answers
here too. However, I would really appreciate if you (or anyone) can
provide me with your version of answers to these questions.
Thanks
MS
On Aug 15, 8:40 pm, u...@att.net (Una) wrote:
>
> read more »
Ruth
First and foremost, welcome to the group and congratulations for the
forthcoming tiny pattering feet.
Una has given you some really fine suggestions, advice and food for
thought. I hope this will help you come to an informed decision.
I will translate your message into French for our French-speaking
members, they may have additional advice or information to give to
you. I will post the French message tomorrow.
I must admit that, if it is at all possible, I find Una’s 4th option
the most reasonable. If an intervention can be avoided before your
natural term there would be less potential harm for both you and your
baby. It would surely also be much less stressful for you than having
to have a midline during your pregnancy. And you could just enjoy
being pregnant
Hugs
Ruth (SCT 1962)
Ruth
Je suis enceinte de 12 semaines et, récemment je fus diagnostiquée
(par échographie et scanner) avec un tératome ovarien, ou kyste
dermoïde, d’environ 8 cm, à l’ovaire gauche.
J’ai eu trois épisodes de douleurs abdominales SEVERES du côté gauche
pendant le mois écoulé. La douleur disparaît automatiquement. Pour
les deux premiers épisodes, au bout de 15-30 minutes, pour le
troisième, après 3 heures.
Mon gynéco me donne 3 possibilités pour l’enlever
1. Faire une intervention immédiatement par incision centrale
2. L’enlever lorsqu’il y aurait un autre épisode de douleur
3. Faire naître mon bébé à 37 semaines, par césarienne, et enlever le
kyste à ce moment-là
Je m’inquiètes des risques encourus pour mon bébé par l’anésthésie
générale, donc personne n’est complètement sur là dessus.
Deuxièmement, si je fais faire la chirurgie maintenant, est-ce que la
cicatrice de l’incision supportera la douleur et les contractions au
moment de l’accouchement? Sinon, les toubibs pourraient opter pour
une césarienne de toute manière.
Que faut-il faire ?
Pologirl
Hi MS
I am glad you took me up on posting here. You are in the "very scary
zone" which I am sure makes a lot of readers feel uncomfortable on
misc.kids.pregnancy. I vaguely remember how uncomfortable I used to
feel, reading about other women's "high risk" pregnancies, and then my
shock and depression when I became one of those women. Now it all
feels normal for me. (My outcome was excellent, by the way.) The
others here have been through much of what is ahead of you.
I can't answer most of your questions but some of them I may be able
to help with. Some of your questions cannot be answered without
examining you and/or your radiology images, and having relevant
expertise. I see you have copies of your radiology reports.
Excellent! Do you also have copies of the images themselves?
Sometimes they are called films but I expect your images are actually
digital and you can get a complete set on a CD or DVD, along with
software to view them.
In all likelihood your CT scans include your baby too; so you should
have a copy just for future reference, even if you never look at them.
MS wrote:
> My doctor did tell me that there is a 2% chance of malignancy, which
> can be called as rare. They have not talked about ruling it out
> though.
odds are about everyone else, not about you. Assuming it is a tumor,
you do not know it is not malignant until after it is removed and sent
to a lab for pathology. So you will have to take chances but you
should not take chances you don't have to take. One way to be pretty
sure the tumor is malignant is to test your AFP; if it is high, the
likelihood of malignancy is high.
You want the MS AFP test (not AFP Tumor Marker) because you are
pregnant and AFP increases due to pregnancy. Results of the MS AFP
test are reported with the baby's gestational age already taken into
account, and are expressed as a multiple of the mean (MoM). One of
the references that Una gave you concerns a case report of a malignant
mixed germ cell tumor detected via MS AFP at 12 MoM. Normal is 0.5 to
2 MoM. In that case report the germ cell tumor was teratoma plus
endodermal sinus tumor (EST). EST is what we parents of teratoma
babies fear, and it makes AFP. Normally, a pure teratoma does not
make AFP. A dermoid cyst is not necessarily a pure teratoma.
Is that making sense so far? Basically, MS AFP might reveal if your
tumor *is* malignant, but cannot prove that it is *not* malignant.
That is because there are other likely malignancies, that do not make
AFP.
There are some other useful blood tests, for other kinds of tumors
that can occur in ovaries. You might want to consult an oncologist.
If your cyst is a tumor and it is malignant, then you may want it out
right now. If it is EST, *I* would want it out right now, so I would
take option #1, or I might want to do chemotherapy right now, and
delay surgery until after delivery. The merits of any approach
depends on exactly what kind of tumor you have. You should know that
if your cyst is malignant, especially if they operate and there is any
risk of spill or incomplete removal, you will be advised to have
chemotherapy too. If they find EST, they will want you to start
chemotherapy right away. If your cyst is not a tumor at all, then of
course you want none of any of that!
Of the three choices offered by your OB, #1 and #3 seem reasonable, as
far as they go. #2 does not make much sense but I suppose your OB
doesn't expect you to choose it. It makes me wonder: does your OB/
GYN doubt the cyst is a tumor? I would want to develop that list of
choices a little more, before making any decision. Eg, for each
choice work out why it is being offered, meaning what existing data
about your case makes it appropriate, and its pros and cons.
Why does your doctor not offer option #4? Is she concerned about the
cyst rupturing during labor and delivery? One of the other papers Una
posted for you addresses that.
Have you thought about getting a second opinion on the ultrasound and
radiology images? Send the entire image sets, on a disk, to another
radiologist. Preferably, a radiologist who has seen lots of ovarian
tumors and/or teratomas.
I guess if it were me, given the choices you face, I would need to
have a better idea of the probability of malignant vs benign, to
decide among what look like your immediate choices: surgery now, chemo
now, and wait-and-see. I think your OB may follow the principle of
"when in doubt, cut it out". Are you the same? That's okay, if you
are. The alternative principle is "wait it out". It may help if you
and your OB are the same in this respect, but there is also something
to be said for being opposites.
> My USG report said: "An echogenic mass measuring 92x48x83mm in the
> left lumber region extending towards and crossing midline. Acoustic
> shadowing due to internal calcification also noted. On color doppler
> no blood flow seen. Therefore a suspicion of Dermoid. A CT scan is
> advised for confirmation"
>
> My question is that is it enough information to suspect a dermoid?
> Secondly, the CT scan report (by the same radiologist) confirmed "a
> 79x77x50mm well defined encapsulated mass in the left lower abdomen
> quadrant. Small amount of calcification at the inferior aspect of
> mass. Conclusion: Left ovarian teratoma"
>
> Once again, does it necessarily indicate a left ovarian teratoma?
of functional cysts. Tumors that are encapsulated tend to be benign,
but not always. Teratomas often do have calcification, but not
always, and they are not the only kind of tumor that can show
something that looks like calcification. A teratoma with
calcification probably is more likely to be benign, than one without.
I suppose checking for calcification is why they used CT (with its
radiation, despite your pregnancy) rather than MRI. The conclusion of
the CT report still is a guess, though. Because teratomas can be
mixed, even if it is mostly teratoma the possibility of EST or other
malignancy cannot be ruled out until after a detailed pathology study,
which necessarily comes long after surgery is over.
> Couldn't it be Corpus luteum cyst? How can the two be differentiated?
answer this question you really need the expert opinion of a
radiologist, or to get your hands on a radiology textbook that covers
in detail the diagnosis of ovarian cysts. Either way, it is a
question about your specific cyst so should be answered only after
looking at your images.
The general method of differentiating between a good and bad cyst
seems to be simply to watch: if the cyst gets bigger, then take it
out. If it shrinks, leave it alone.
> Also you would have noticed a difference in the size in both the
> reports. Is it within the normal margin of errors?
tumor varied a lot, partly for biological reasons, partly because the
measurements are based on images and there is some distortion, and
partly because different people chose different points to measure. I
saw them do that. You said the same radiologist wrote both the US
report and the CT report. Did the same radiologist also do both
measurements, or were they done by different people?
If the difference is real then it is good news for you, because the
later measurement is smaller. If the cyst continues to get smaller,
then it is likely not a tumor. On the other hand, my baby's mostly
solid tumor was spotted because it blew out a great big fluid cyst,
which then shrank in just a few weeks. By the time she was born it
was long gone. The rest of the tumor, which was inside her pelvis,
was invisible on most ultrasound exams (I had about 30 of those). We
knew it was there because it was plainly visible on MRI and also
because it pushed her bladder up into her abdomen.
I think you are in good hands with your medical team. They seem to
have a clue and are making plans. My local team said "we can't handle
this" and referred me to others who, ahem, had no clue but pretended
they did. I referred myself to others who did have a clue.
Well, this post has ended up being way too long ... I hope it helps.
Pologirl
Una Smith
I am also wondering about those choices. Is #2 actually "wait and watch",
indefinitely? Or is it in series between #1 and #3? If the latter case,
then the choices really are:
#1 before 24 weeks
#2 from 24 through 36 weeks, when the baby may survive in the (unlikely)
event there is a major complication of surgery
#3 at 37 weeks, when the baby is nominally full term, in conjunction with
a C-section
The relative risks of these choices are very difficult to judge, and they
depend a lot on the answers to two questions: Is the cyst a malignant
tumor, or not? Is the pain is due to torsion or necrosis of the cyst, or
unrelated? Malignant tumor, torsion, and necrosis need prompt treatment.
Otherwise you may need no treatment.
If #1 is the best option, then as far as the risk of complications goes it
is better done sooner than later. But, waiting a few weeks gives you time
to find out more about the cyst.
Una
MS
I am sorry that I am writing back after a while. I was kind of in a
limbo and indecisive (which I still am). Anyway, here are the results
of my MS-AFP
Serum A-Fetoprotein = 21.06 IU/ml
Reference values (gestational weeks (+/-3 days), median values
14 weeks ... 20.9 IU/ml
15 weeks ... 24.0 IU/ml
16 weeks ... 27.6 IU/ml
My LMP is 13-May-08 so I was 13.3 weeks on the day the sample was
drawn. I calculated my MoM value to be approximately 1.10. I've used
the formula on the following website to calculate it
http://www.som.tulane.edu/classware/pathology/medical_pathology/prenatal/06-mom.html
So it seems to be a good sign .. right?
Secondly, I have had no more episode of that pain (for the last 15
days atleast). That is another good sign.
Can I conclude that I shouldn't go for the surgery until after the
delivery, or not yet?
Thanks
MS
Pologirl
Hi MS!
MS writes:
> I am sorry that I am writing back after a while. I was kind of in a
> limbo and indecisive (which I still am).
That's okay. I remember being in limbo myself, and you are gathering
information that you need to make a wise decision.
> Serum A-Fetoprotein = 21.06 IU/ml
>
> Reference values (gestational weeks (+/-3 days), median values
> 14 weeks ... 20.9 IU/ml
> 15 weeks ... 24.0 IU/ml
> 16 weeks ... 27.6 IU/ml
>
> My LMP is 13-May-08 so I was 13.3 weeks on the day the sample was
> drawn. I calculated my MoM value to be approximately 1.10. I've used
> the formula on the following website to calculate it
>
http://www.som.tulane.edu/classware/pathology/medical_pathology/prenatal/06-mom.html
>
> So it seems to be a good sign .. right?
Yes, a very good sign. What a relief! That AFP value is great
news for you re both the cyst and the baby.
Thank you so much for finding that web page. I expect you got the
calculation exactly right, but alas the equations (graphs?) don't
display for me. Could you do me a favor? Print the page to a PDF
and e-mail the PDF to me?
> Secondly, I have had no more episode of that pain (for the last 15
> days atleast). That is another good sign.
Yes, another very good sign. Maybe it was round ligament pain...
Here is a good illustration of the relevant pelvic anatomy:
http://en.wikipedia.org/wiki/Image:Gray1165.png
(Note also at the bottom of the page, links to Wikipedia articles
that use the image; those articles may have information for you.)
See how the round ligament connects to the fallopian tube. I can
imagine how having a cyst on the left ovary might contribute to
round ligament pain on the left side. Just a thought.
> Can I conclude that I shouldn't go for the surgery until after the
> delivery, or not yet?
That question you have to answer for yourself. As I tried to say
before, there are unknowns and you may not get enough information
until *after* you have surgery, no matter what you decide now. So
in a sense it is a question of what works for you. Are you a "get
it out, now!" person or a "wait and see" person? Also, follow you
instincts. If you feel you don't have enough information to make
a decision, then get more information. Eg, are you scheduled for
a future US to monitor the cyst? Think about contingencies. If
the next US shows the cyst is notably smaller, the same, or larger,
how would that information affect your decision making? If it
would make no difference, then there is no reason to wait until the
US to make your decision. If it would make a big difference, that
is a reason to postpone deciding until after the US. A 2nd opinion
is a kind of information too. In seeking a 2nd opinion, your
burning questions would be something like these:
Qs for a radiologist:
Is the cyst a neoplasm?
Is the cyst a teratoma?
Qs for an obstetrician:
What is the risk of dystocia due to the cyst?
What is the risk of cyst rupture during labor and vaginal delivery?
What is the risk of complications, for a baby delivered at 37w?
If surgery to remove the cyst is postponed until after and apart
from a C-section, could the C-section be on the bikini line rather
than a classical abdominal midline? (This lessens the risk of
uterine rupture in subsequent pregnancies.)
One of the links from that page led me to this really useful page:
http://www.webmd.com/baby/pregnancy-round-ligament-pain
It does a great job of outlining what can cause lower abdominal
pain during pregnancy, and mentions the potential for confusion re
cause.
How are you doing otherwise?
Pologirl
MS
> Thank you so much for finding that web page. I expect you got the
> calculation exactly right, but alas the equations (graphs?) don't
> display for me. Could you do me a favor? Print the page to a PDF
> and e-mail the PDF to me?
but it bounced back.
> See how the round ligament connects to the fallopian tube. I can
> imagine how having a cyst on the left ovary might contribute to
> round ligament pain on the left side. Just a thought.
Another interesting observation is that around a month ago, I could
feel a solid round object in my abdomen (before they told me about the
cyst). I could even feel it moving/sliding inside my abdomen as soon
as I would change to a right lateral lying position. I wouldn't feel
anything in the left lateral position. Now the feeling of movement or
sliding is completely gone. So I was thinking that since the uterus
has grown larger in size, it might have packed my left ovary in a
corner. If that is the case, it would be kept packed since the size of
my uterus will only grow in the coming months. That would be good,
right?
> in a sense it is a question of what works for you. Are you a "get
> it out, now!" person or a "wait and see" person? Also, follow you
> instincts.
> a decision, then get more information. Eg, are you scheduled for
> a future US to monitor the cyst? Think about contingencies. If
> the next US shows the cyst is notably smaller, the same, or larger,
> how would that information affect your decision making?
hope it has reduced in size. If it has grown larger, that would be
unusual of a dermoid cyst (to increase in size in such a short period)
that would be alarming I think.
All the questions you are suggesting are really good and relevant. I
will be asking them in my next visit.
I've been doing well otherwise. Initially, after the previous episode
of pain, I was quite scared, but as the time is passing, I am feeling
better and more in control. Although any alarming news would shatter
all the composure i've gained during the last week or two :)
Thanks again
MS
On Aug 29, 3:00 am, Pologirl <polog...@att.net> wrote:
> Hi MS!
>
> MS writes:
> > I am sorry that I am writing back after a while. I was kind of in a
> > limbo and indecisive (which I still am).
>
> That's okay. I remember being in limbo myself, and you are gathering
> information that you need to make a wise decision.
>
> > Serum A-Fetoprotein = 21.06 IU/ml
>
> > Reference values (gestational weeks (+/-3 days), median values
> > 14 weeks ... 20.9 IU/ml
> > 15 weeks ... 24.0 IU/ml
> > 16 weeks ... 27.6 IU/ml
>
> > My LMP is 13-May-08 so I was 13.3 weeks on the day the sample was
> > drawn. I calculated my MoM value to be approximately 1.10. I've used
> > the formula on the following website to calculate it
>
Pologirl
MS wrote:
> Another interesting observation is that around a month ago, I could
> feel a solid round object in my abdomen (before they told me about the
> cyst). I could even feel it moving/sliding inside my abdomen as soon
> as I would change to a right lateral lying position. I wouldn't feel
> anything in the left lateral position. Now the feeling of movement or
> sliding is completely gone. So I was thinking that since the uterus
> has grown larger in size, it might have packed my left ovary in a
> corner. If that is the case, it would be kept packed since the size of
> my uterus will only grow in the coming months. That would be good,
> right?
uterus. A couple of my US exams included checking my "adnexia", and
my ovaries were not always found in exactly the same place. Although
abdominal and pelvic organs are tethered inside the abdominal cavity,
to some extent they all float in there and can "mix it up". Your
story is an excellent example of that.
> I will be asking my doc to advise me another USG. It is a good idea. I
> hope it has reduced in size. If it has grown larger, that would be
> unusual of a dermoid cyst (to increase in size in such a short period)
> that would be alarming I think.
literature is that aggressive growth would require urgent (not
emergency) surgery. Such a teratoma would be a so-called malignant
teratoma, because it has shown aggressive growth, and qualifies as a
cancer.
Cystic teratomas of the ovary are relatively common; malignant
versions of them are rare.
Many experts on these teratomas suspect they are congenital, meaning
present since birth. They are found at almost any time of life, when
they become so large that they cause symptoms. Small ones are found
by chance during pelvic exams and prenatal ultrasounds that check
adnexia.
That reminds me... Have you ever had a pelvic exam? The kind where
the examiner puts fingers in your vagina and holds the other hand
against your abdomen, in order to feel your uterus and ovaries? If
you had such an exam and no large left ovary was noted, either your
cyst is an ordinary functional one (good) or it is a cystic teratoma
that has recently enlarged (bad). A followup US should help to
distinguish between the two.
Remember to take one day at a time. You are entering the 2nd
trimester, which for many women is a wonderful time.
Best wishes,
Pologirl
MS
I am 24w now. No more pain episodes. and had two USG exams during the
last two months. The baby is fine and the size of my cyst has not
increased/changed. Hopefully, the remaining 16 weeks of my pregnancy
will pass without a problem. I will have two options for the delivery
after that:
1. Natural delivery and a surgery to remove the cyst a few months
after my baby is born. I will be concerned if there is a risk of
obstruction or other problems that the cyst can cause during delivery.
2. Get the cyst removed and baby delivered in a single surgical
procedure that involves a midline incision. I will be concerned about
my future pregnancies or other possible complications due to the
midline incision.
I will ask these questions to my Ob/gyn and will keep you posted.
Meanwhile, if you can also share your opinions, it would be great.
Thanks,
MS
Una
well.
MS wrote:
> I will be concerned if there is a risk of
>obstruction or other problems that the cyst can cause during delivery.
Well, where in your body is the cyst now? If it is not near
the pelvic outlet, how could it cause an obstruction? Looking
at MRIs from my pregnancy, I see my ovaries were nowhere near
the danger zone and they were well cushioned by my intestines.
Apart from obstruction (dystocia), are you concerned about any
specific problems?
No change in the cyst over months does favor the diagnosis of
a teratoma, rather than a functional cyst.
>2. Get the cyst removed and baby delivered in a single surgical
>procedure that involves a midline incision. I will be concerned about
>my future pregnancies or other possible complications due to the
>midline incision.
They would want to schedule this, because it won't be just a
C-section. (The procedure to remove an ovarian tumor via
laparotomy includes looking around in your insides for any
other problems.) To ensure it happens as scheduled, they will
want to do it at 37 or 38 weeks. In addition to possible
complications for you, there is a small risk that the baby
will be immature and will have complications as a result.
Although many babies are "ready" at 37 weeks, some are not.
You might want to ask the OB chosen to do the surgery, about
whether the uterus necessarily would receive a classical
midline incision. That is a separate issue from the type
of laparotomy they propose.
http://en.wikipedia.org/wiki/Laparotomy
http://en.wikipedia.org/wiki/Caesarean_section
Have you discussed with the OB whether they plan to spare
the ovary? If they are confident that the cyst is a benign
teratoma, another option would be laparascopic surgery, or
even surgery via your vagina. Both are minimally invasive
procedures but require special non-obstetric training so
likely are not available from your OB.
I am sorry for this slow reply. Perhaps everyone else is
away? I hope this brainstorming helps you to find answers
to your questions and find new questions to ask.
Wishing you good baby vibes,
Una