First-trimester ovarian cysts often resolve

OB/GYN News,  Feb 1, 2003  by Sherry Boschert

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NEW YORK -- Ovarian cysts spotted when pregnant women undergo first-trimester ultrasounds usually resolve spontaneously, and only a few require intervention, Dr. G. Condous reported.

He and his associates prospectively checked the ovaries in 3,000 women who had ultrasound exams before 14 weeks' gestation. Five percent of the women had either a complex ovarian cyst or a simple cyst that was 25 mm in diameter or smaller, Dr. Condous reported in a poster presentation at the 12th World Congress on Ultrasound in Obstetrics and Gynecology.

Only 6 women (0.2%), or 2 of every 1,000 women, required intervention because of ovarian cysts.

"Examining the ovaries in the first trimester is of limited value," said Dr. Condous of St. George's Hospital Medical School, London.

The investigators repeated ultrasound scans on women with ovarian cysts every 4-6 weeks until the cyst resolved, intervention was required, or the pregnancy was terminated. If a cyst persisted at 20 weeks, they rescanned the patient at 6 weeks' post partum. They used transvaginal ultrasound up to 14 weeks' gestation and transabdominal ultrasound after that.

Sixteen women were lost to follow-up. Seventy percent of 142 ovarian cysts in the remaining 137 women resolved spontaneously, 26% persisted at the postpartum visit, and 4% required intervention. The mean cyst diameter was 47 mm, he said at the meeting, sponsored by the International Society of Ultrasound in Obstetrics and Gynecology.

Overall, the investigators found one case of borderline malignancy but no malignancies. The presumed diagnoses based on ultrasound features included 104 physiologic cysts, 12 dermoid cysts or benign teratomas, 1 mucinous cystadenoma, 19 serous cystadenomas, 3 endometriomas and 3 borderline tumors. The ultrasound features showed 99 simple or anechoic cysts, 24 hemorrhagic cysts, 12 with mixed echogenicity, 1 with low-level echoes, 3 with a ground-glass appearance, and 3 solid/cystic lesions with papillary projections.

Interventions in six cases included one transabdominal aspiration, two laparotomies, one laparoscopic cystectomy, and two ovarian cystectomies at the time of C-section delivery.

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