Abstract:
The incidence of ovarian tumour in pregnancy varies widely from 1 in 81 (1) to 1 in 8000 (2) live births in the earlier literature. On a more recent literature, an incidence of 1 in 505 (3) has been reported. Majority of the ovarian tumours found during pregnancy were benign but between 2.4 to 5.3% (4, 3) of those were found to be malignant. In recent times, detection of ovarian tumours during pregnancy was increased due to routine prenatal ultrasound checkups. As a result, there is an increased need to distinguish between a benign versus malignant ovarian tumour. This is often challenging as decidualised benign ovarian cyst may mimic features of malignancy. Other challenges lie in the decisions regarding the need to operation and when to operate on such ovarian tumours. Most symptomatic tumours or those showed borderline or malignancy features on ultrasound are ones likely to require surgery. Historically, pregnant women with symptomatic or suspicious masses underwent elective removal in the second trimester (12) and this is relatively safe. Any surgical Intervention beyond the 24 weeks’s gestation is associated with poorer obstetric outcome such as spontaneous miscarriage, preterm labour or preterm premature rupture of membranes (13). The decision to operate hence is a challenging one especially when one needs to balance between the upstaging of the suspicious malignant ovarian mass and the wellbeing of the fetus. Here we report a case where decidualised haemorrhagic ovarian cyst without evidence of endometriosis showed excresence which obliged us to perform surgery during pregnancy. As the findings were found in the 3 rd trimester, the operation along with a caesarean section was carried out prematurely at 35 weeks of gestation to achieve fetal maturity, fetal wellbeing as well as the possibility of staging operation in the form of total abdominal hysterectomy oophorectomy if tumour was deemed malignant.
