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Overview

In the first trimester of pregnancy, some women may develop ovarian cysts which are found on routine ultrasound examination of the developing fetus.

In most cases, these cysts are non-cancerous and around five centimetres in diameter. Ovarian cysts that are noted during the first trimester usually resolve on their own by the beginning of the second trimester.

Dermoid cysts are ovarian cysts found during pregnancy that are larger than five centimetres and very rarely lead to ovarian cancer.

Causes

Each and every month, women produce cyst-like structures called follicles and these will release an egg. This phase is referred to as ovulation.

After the end of ovulation, the follicle deflates normally but sometimes fluid builds up in this tissue resulting in a simple (follicular) cyst which only contains fluid. When totipotential germ cells, which are present at birth, divide or differentiate abnormally though, a dermoid cyst will develop.

When dermoid cysts are present during pregnancy, they may affect the development of the fetus. Sweat glands, fatty tissue, hair, and oil glands can become trapped in the skin of the baby.    

It can take months or even years before dermoid cysts are noticed on a child because they are slow-growing lesions.

The symptoms caused by dermoid cysts are minor and the lesions are usually painless. The masses are also not detrimental to the child's health.

Risk Factors

Risk factors linked with the development of ovarian cysts may include the following:

  • Obesity.
  • Irregular menstruation.
  • Hypothyroidism which is having an underactive thyroid.
  • Having a history of previous ovarian cysts.
  • Early menarche (menstruation at an early age), usually before 11 years of age.
  • Infertility
  • Using medication such as tamoxifen for the treatment of breast cancer.

Complications

Dermoid cysts can become complicated and issues can arise such as infection, torsion (twisting) of the mass, and even rupture of the cyst.

These masses can sometimes become so large that surgical intervention may be necessary to remove them. This is especially the case if they are posing a risk to the health of the affected individual.

Emergency Intervention

Patients diagnosed with ovarian cysts may develop symptoms and signs that warrant immediate medical care and include:

  • Fever.
  • Fainting or dizziness.
  • Fatigue.
  • Persistent and severe nausea and/or vomiting
  • Severe pain or tenderness involving the lower abdomen or pelvis.
  • Skin pallor due to potential blood loss.
  • Abnormally heavy or irregular menstruation. 
  • High or low blood pressure.

Management

If the affected individual doesn't exhibit any symptoms and signs of an ovarian cyst, the mass is monitored routinely with ultrasound examinations and left to resolve on its own.

Cysts that cause minor symptoms will be surgically removed just after midway through the pregnancy and this will be done by either performing keyhole surgery, referred to as a laparoscopy. If the cyst is very large or the patient is in the late stages of the pregnancy, an open surgery called a laparotomy will need to be performed.

If complications develop because of the cyst, then surgery will have to be performed regardless of the stage of the pregnancy.

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