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Re: 23w pregnancy with big ovarian cystFrom: Marco A. Pelosi, III, MD (marcop@tao.agoron.com)Tue Apr 28 11:26:12 1998
At Tue, 28 Apr 1998, baranakis haris wrote: 24yo ,2p, 2g and 23 w >pregnant now , 1st baby with cesarean section. I made a scan and i found >a big cyst ( guess ovarian) 10 cm outside uterus. At 1st trimester scan >the cyst was 3 cm without any symptoms. Now she complains about low >abdominal discomfort and i notice an on the right dislocation of the >uterus. I am afraid of 3 trimester complications so i decided to remove >cyst. I haven't other experience with pregnancy complicated with big >ovarian cyst so i wonder what would be the best approach, so i want >your advice. > a. Open surgery and cyst removal > b. laparoscopic puncture of the cyst and if is safe as well removal( >laparoscopy is contradicated at pregnancy?) > c. transdermal or transvaginal puncture of the cyst with u/s guided >needle aspiration > d. any other suggestion? >i vote c if i can find a good window. What are the possible >complications? > >Varanakis Haris Dr. Haris, Puncture of the cyst may have subsequent catastrophic results if malignant. Furthermore, if benign, both mucinous and dermoid cyst fluid can cause an extensive peritoneal reaction. The bottom line is simple - the patient needs surgical evaluation before the pregnancy advances further and preterm delivery becomes an issue. The surgical approach depends upon your level of experience with laparoscopic adnexal surgery and serious consideration given to the difficulty of working along the pelvic brim around a 23-week-sized uterus that you can't touch. A quick operation under regional anesthesia and with minimal manipulation is best in this setting. Good luck.
-- M.A. Pelosi, III, MD
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