21 yr old, 15 wks pregnancy (spontaneous conception) presented with distention in abdomen with difficulty in respiration but comfortable. Mild pain in abdomen. USG revealed 2 large b/l multi-locular masses, each measuring ~25 cm in size, reaching up to liver. Each mass contained >20 small cysts containing clear fluid and thick septa in between. No ascites and no e/o torsion/twist on doppler. SIULF ~ 14 weeks. Ovaries not seen separate. Serum testosterone and TSH very high. After 7days her respiratory distress increased so Laparotomy (JC incision) was done to aspirate cysts in both ovaries. Drain kept intraperitoneally. Today is D5 of the surgery and still she is draining 300ml clear fluid/day. Testosterone has reduced now. But now she is leaking from drain site also soaking the dressing completely. Drain is not removed yet. I did literature search nowhere termination is indicated. How much time it will take to settle or any other suggestions.
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GOOD NEWS. Drain was removed 4 days back. No soakage since then. Trrw she will be discharged. No ascites today. She did not require either albumin or lasix. Although i am giving her high protein diet.
I had a similar situation in Residency. It was with a twin pregnancy. We ended up draining many of the cysts with an amnio needle under ultrasound guidance. After several days, the site from which we drained the cysts began to leak. I'd recommend against the drains for that very reason. She'll continue to put out fluid until the pregnancy is complete. I agree, this isn't necessarily an indication for termination apart from her own desires of the pregnancy. high protein diet sounds like a good idea, but probably won't make much of a difference. My guess is the cysts will progress until the pregnancy is over, then regress in a short amount of time.
How is she doing??
she stopped leaking in 5 days and sutures removed on D8. Followup scan after 1 month revealed only one small cyst with no ascites. She is now 2 months after the surgery and baby is growing well. It is self limiting disease and regresses after 16-20 wks gestation.
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