33 years, G1P0, nearly 24 weeks,with huge ovarian cyst about 30 cm, otherwise normal. after cystectomy, is it better to fix the ovary ? and what are the best methods in pregnant female with vascular uterus and bulky vascular ligaments? what about lateral fixation to lateral pelvic wall?
any mucinous cystadenoma encountered in pregnancy around 30weeks,one needs to exclude malignancy before provcedding further using malignant fluid cytiology,staging after feeling praaortic lymph nodes as as much as 50%of mucinous cystadenomas can turn to be assoc with malignancy ,so tumr markers done before hand and since biposy from opp ovary may not be feasible in lieu of disturbing CL,ONE TAKES THE SAFER COURSE OF LEAVING THE OVARIES AS IT IS RATHER THAN INTERFERING MORE WITH THE ANATOMY AND RISK OF TWISTING IN SUCH A BIG OVARIAN VCYST IS UNLIKELY.
As she is pregnant, I would think MRI would be better option to assess extent of tumour and evidence of extra-ovarian spread. In pregnancy, most of the tumour markers (like CA125, AFP, hCG, Inhibin) are of no use as they physiologically increase in pregnancy. And for obvious reason, even if malignancy is suspected, we cannot go for radical surgery now. So, better to proceed with cystectomy (if needed ovariotomy of the afected side) along with peritoneal fluid cytology. As she is already 24 wk, pregnant uterus can hinder access to pelvic and para-aortic lymph nodes. I don't think ovariopexy is necessary here. But after operation, tocolytic and progesterone support can be considered, with informed risk consent (as the surgery may excite preterm labour). Finally, if laparoscopy facility is available, it can be considered by expert personnel.
according to the previous setting of the ovary is the most important thing is not necessary rule out malignan
It is better rather not to fix the ovary at advance stage of pregnancy.
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