EP23.34: Unilocular symptomatic cyst in a pregnant woman: what is the best approach?

Unilocular cyst is a common ovarian ultrasound finding that can occur on fertile women. Due to the anatomical displacement alteration of the adnexal out of the pelvis, during pregnancy, the risk of ovarian torsion is higher when associated with a cyst. The presented case involves a 33-year-old woman, 3G1P1A, with a spontaneous pregnancy and a last menstrual period (LMP) equivalent to ten weeks of gestation. She was admitted to our emergency department with an abdominal pain located in her right iliac region, lasting 1 day with no relief after home analgesia. Upon admission, the patient was stable, vital signs within the normal range. Abdominal examination revealed a mass located in the right iliac region associated with pain and defence. Transvaginal ultrasound revealed an intrauterine gestational sac with an embryo consistent with the LMP and fetal heartbeat. Upon analysing the adnexal areas, a 79x70x73mm unilocular cyst was detected in the right ovary, with anechoic content and a whirlpool sign, suggestive of sub-tortion of the right ovary. An ultrasound-guided fine needle aspiration was performed, resulting in the evacuation of 225cc serous fluid that was sent for cytological examination. Following the procedure, a vaginal ultrasound was repeated, revealing a cyst measuring 44x25x43mm.The patient experienced clear improvement of abdominal pain. The aim of this paper is to demonstrate an alternative non-invasive procedure for unilocular cysts with ovary sub-torsion, which reduces the risk of miscarried. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.