Evaluation of Pregnancy Outcomes after Laparoscopic Resection of Benign Ovarian cysts During First and Second Trimester of Pregnancy

Abstract

Majority of adnexal masses are incidental findings during pregnancy and resolve spontaneously. They may complicate pregnancy due to haemorrhage, cyst rupture and ovarian torsion. Laparoscopy is the preferred surgical intervention owing to shorter operative time, quicker recovery and lower post‑operative pain. However, safety and feasibility of laparoscopic surgery in the management of ovarian cysts in pregnant women is challenging especially at advanced gestational ages and in urgent situations. Our aim is to demonstrate the feasibility and effectiveness of laparoscopic management of attached masses in pregnancy, even in emergency situations. Methods: This study is a retrospective study. In this study, all pregnant patients who were treated during the last three years from the first of 2017 to the first of 2014 due to the complications of ovarian cysts in the first and second trimesters of pregnancy at Al-Zahra Hospital Center in Tabriz. Laparoscopic resection of ovarian cysts was investigated. Patients are examined in terms of maternal and fetal outcomes during pregnancy and possible complications during surgery. All patient information including age, weight, number of pregnancies and deliveries, previous delivery method, ovarian cyst history before pregnancy, ovarian cyst drug treatment history, surgical method, gestational age, need for oophorectomy, cyst drainage before its resection, duration Neonatal procedures and complications such as delivery method, premature delivery, birth weight, Apgar score and fetal death were investigated in all patients. Also, the placement of trocars, the number of ports used, the condition of the patient during surgery, the amount of injected gas and intra-abdominal pressure during surgery, the conversion rate to laparotomy, uterine and visceral damage due to the entry of ports were all among the priorities. Results: The operations were ended in all patients successfully. The mean operation time was 45 min. There were no foetal maternal complications. All pregnancies had been terminated after 37 weeks of gestation. Oophorectomy had been performed in six patients and six other patients needed blood transfusion. Ovarian torsion was the most common reason for emergency surgery and mature teratoma was the most commonly reported pathology. Tocolytic therapy was required in six patients, and all of the patients were prescribed 50 mg of injectable progesterone twice daily for 10 days after surgery. The mean intra‑abdominal pressure was equal to 15 mmHg and the mean end‑expiratory carbon dioxide (CO2) pressure was 36 mmHg. Intravenous paracetamol was used to relieve post‑operative pain. The mean hospitalisation time was 1.63 days.