Bali Medical Journal (Bali Med J) 2015, Volume 4, Number 1: 5-7
P-ISSN.2089-1180, E-ISSN.2302-2914

GIANT OVARIAN CYST IN TERM PREGNANCY
- A rare case report
1

Basanta Manjari Hota, 2K Radha Rukmini, 3Prabhakar Gowdar Channa Basavaih
1

Senior Resident, Obstetrics & Gynaecology
Post graduate resident, Obstetrics & Gynaecology
3
Professor, Obstetrics & Gynaecology
Department of Obstetrics & Gynaecology, Mamata Medical College & General Hospital,
Khammam – 507002 Telengana (India)
2

Ovarian cyst in pregnancy may have a poor feto-maternal outcome. A 25 year old multi gravida, post
caesarean pregnancy at term reported with antenatal ultrasonography (USG) diagnosis of giant
unilocular ovarian cyst and normal obstetrics findings. Elective lower segment caesarean section
(LSCS) with left salpingo-oophorectomy and right partial salpingectomy was done. Left ovarian cyst
was 29x20 cm in size with smooth surface, no adhesion, no free fluid in peritoneal cavity and a normal
right ovary. Histopathological examination revealed mucinous cystadenoma of ovary. Post-operative
period was uneventful. The rarity of the case and its successful management prompted us for reporting
along with review of literatures.
Keywords – Mucinous cystadenoma, pregnancy.
INTRODUCTION
Incidence of ovarian cysts in pregnancy is less
than 1% (1 in 1000) and most of them are benign in
nature. Giant ovarian cysts are found only in less
than 1% cases of all ovarian cysts in pregnancy.
Functional cysts are common in first trimester.
Beyond 16 weeks of gestation, Dermoid and
mucinous cyst are found constituting 60% of total
adnexal mass during pregnancy1. Symptoms and
signs are usually related to those associated with
pregnancy unless the size is very large or
complications like torsion, rupture, secondary
changes or infection occur in the cyst. Large size
may affect the fetal growth,
mal-presentation,
obstructed labour, rupture of the cyst in addition to
wrongful calculation of gestational age and so
also increased maternal morbidity due to over
distension of abdomen. Hormone producing tumour
has effect on both mother and fetus. We present a
case of giant ovarian cyst, which was first presented
at term gestation and was managed successfully
without any complication.

Correspondence address
Dr. Basanta Manjari Hota,
Senior Resident
Department of Obstetrics & Gynaecology,
Mamata Medical College & General Hospital,
Khammam - 507002
Telengana (India)
E-Mail: drmanjarihota@gmail.com

Case report
A
25 year old woman, G3P1L1A1 with
previous LSCS, at 37weeks and 3 days of
amenorrhoea, an unbooked case reported to
antenatal OPD on 29.09.14. She was an educated
lady of lower middle class socio-economic group.
She was a known case of hypothyroidism with
thyroid hormone supplementation. She was taking
regular antenatal care. Last USG was taken 3 days
back, which revealed a left sided large ovarian cyst,
for which, she was referred to a higher centre for
further management.
She was having discomfort for over distension
of abdomen; otherwise she had no major complain
on admission. Foetal movements were normal.
She conceived spontaneously 2years after one first
trimester abortion. During the present pregnancy,
her first and second trimester periods were
uneventful. Antenatal USG in second trimester was
reported to be normal as per gestational age and had
no mention of ovarian cyst. Third trimester USG
diagnosed the cyst and obstetric reporting was
within normal limit.
Her first delivery was by LSCS for post-dated
pregnancy with failed induction and intra and
postoperative period was uneventful. Second
pregnancy, after 6 months of LSCS was terminated
in first trimester abortion .There was no relevant
past or family history. Her LMP was 09.01.2014
and EDD 16.10.2014 with past menstrual history of
3days / 30 days cycle.
On examination she was 162cm in height with
a weight of 71 kg. Her vitals
were stable; she

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Bali Medical Journal (Bali Med J) 2015, Volume 4, Number 1: 5-7
P-ISSN.2089-1180, E-ISSN.2302-2914

had mild pallor and mild bilateral pedal oedema.
Cardiovascular and respiratory systems were
clinically normal. Abdomen was over distended
with a healthy suprapubic transverse scar of
previous LSCS surgery. Abdominal girth was
107cm and flanks were full. Symphysio-fundal
height (SFH) was 37cm. Uterus was
relaxed
with longitudinal lie, cephalic presentation,
unengaged, left occipito anterior position with no
scar tenderness. Fetal heart rate (FHR) was 140 /
min.
Investigations showed Hb% - 9.6gm% and
blood group - O+. Other haematological and
biochemical parameters were
within
normal
limit. USG abdomen and pelvis reported
an
unilocular ovarian cyst of 21x18cm size and
normal obstetric findings corresponding to her
gestational age. With the diagnosis of G3P1L1A1
post - LSCS pregnancy at term with large ovarian
cyst, elective LSCS with salpingo-oophorectomy
was planned.
She
underwent
LSCS
under
spinal
anaesthesia. An alive female baby of 2.8 kg was
delivered. A left ovarian cyst of 29 cm x 20 cm
sizes with clear fluid inside was found behind the
uterus, well cushioning it, extending to all
quadrants of abdomen. As the cyst was not tense
with fluid it could be exteriorised by shifting fluid
from one to other part of the cyst and removed in
toto (Figure 1). Weight of the cyst after removal
was 4.9 kg (Figure 2). There was no free peritoneal
fluid or adhesion and other ovary was found
normal. Left salpingo - oophorectomy with rt.
Partial salpingectomy (sterilisation)
was done.
Histopathological examination (HPE) of the
specimen reported mucinous cystadenoma of ovary.

Figure 2
Resected Ovarian cyst (4.9 kg)
DISCUSSION
The clinical entity of an ovarian cyst with
pregnancy is rare. It may result in serious maternal
and fetal complications. Most of the ovarian cysts
in early pregnancy are usually detected by USG.
Management depends on the symptoms, character
of the cyst and gestational age. A cyst of less than 6
cm in size, asymptomatic, without features of
malignancy is usually managed conservatively.
Otherwise elective surgical intervention in second
or third trimester or emergency
surgery
as
required is contemplated. Mucinous cystadenoma is
a benign epithelial tumour with multilocular, thin
walled cyst having smooth external surface and
contains mucinous fluid. It constitutes 12-15% of
ovarian tumours and the largest of all ovarian cysts.
75% of all the mucinous cystadenoma are benign,
whereas 10% are border line and 15% are
malignant2. There are reports of huge mucinous
cystadenoma in pregnancy needing emergency
surgery 3-5.
Qublan et al. reported
mucinous
cystadenoma
of
6300 gm at 38 weeks of
pregnancy with IUGR and malpresentation.6 This
was not seen in this case as the cyst was not tense
with fluid. Virilisation has been reported in
mucinous cystadenoma in pregnancy where
HPE showed stromal cells resembling Lutein or
Leydig cells.7,8
CONCLUSION
Ovarian cyst in pregnancy must be followed
up carefully
as
the
prognosis
is
unpredictable. Early diagnosis,
timely
and
appropriate intervention is the key to the best of
feto-maternal outcome.

Figure 2
Left ovarian cyst being exteriorized during LSCS at
term with live baby (2.8 kg)

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cystadenoma
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P-ISSN.2089-1180, E-ISSN.2302-2914

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