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Overview

During the first trimester of pregnancy, some women may be diagnosed with ovarian cysts on routine ultrasound examination of the developing fetus. Most of the time these cysts are benign, simple cysts that are small in size (about 5 cm in diameter). The cysts that are found in the first trimester usually resolve on their own by the beginning of the second trimester.

If the masses are larger, then these are often referred to as dermoid cysts. Very rarely, ovarian cancers are a cause of large ovarian cysts in pregnancy.

Causes

The normal process of an ovary is to produce cyst-like structures called follicles each month which release an egg during the stage of ovulation. When this happens the follicle normally deflates but sometimes fluid builds up in this structure resulting in a simple (only fluid containing) cyst, also known as a follicular cyst. Now, dermoid cysts develop from totipotential germ cells (present at birth) that differentiate/divide abnormally.

During pregnancy, these cysts may affect the developing fetus and develop when skin cells and tissue such as sweat glands, hair, fatty tissue, and oil glands become trapped in the skin.    

Regarding dermoid cysts that are present at birth, it can take months or even years before it is noticed on a child because they grow so slowly. The symptoms caused by dermoid cysts are minor and are usually painless. They are also not harmful to the child's health.

Risk Factors

Risk factors associated with the development of ovarian cysts include the following:

  • Having a history of previous ovarian cysts.
  • Obesity.
  • Irregular menstruation.
  • An underactive thyroid gland (hypothyroidism).
  • Infertility.
  • Having started with menstruation at an early age (11 years or younger).
  • Using Tamoxifen for the management of breast cancer..

Complications

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

Sometimes the dermoid cysts can become so large that surgical intervention may be necessary to remove them if they are posing risks to the affected individual's health.

When to Seek Immediate Medical Care

Patients known with ovarian cysts and who present with the following issues should contact a healthcare professional or present to an emergency room as soon as possible:

  • Fever.
  • Abnormal or severe tenderness or pain located in the lower abdomen or pelvis.
  • Dizziness or fainting.
  • Generalized weakness.
  • Pale skin due to possible blood loss.
  • Persistent nausea or vomiting.
  • Abnormally irregular or heavy menstruation. 
  • High or low blood pressure.
  • Unexplained shoulder pain together with that experienced in the abdomen or pelvis.

Management

The important point here is that if there are no symptoms caused by the cysts during the pregnancy or any other time, the masses are monitored routinely with ultrasound examinations and left to resolve on their own.

Cysts found during pregnancy that cause minor symptoms will be removed at just after the halfway point of the pregnancy. This will be done by either performing a laparoscopy (keyhole surgery) or if the cyst is very large or the affected individual is in the late stages of the pregnancy then a laparotomy (open surgery) will need to be performed.

If complications arise as a result of the cyst, then surgery will have to be performed regardless of the stage of the pregnancy.

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