25/09/2026
๐ ๐ฌ๐๐๐จ๐ง๐ ๐จ๐ฉ๐ข๐ง๐ข๐จ๐ง ๐๐๐ง ๐ฌ๐จ๐ฆ๐๐ญ๐ข๐ฆ๐๐ฌ ๐๐ก๐๐ง๐ ๐ ๐ญ๐ก๐ ๐๐ง๐ญ๐ข๐ซ๐ ๐ฌ๐ญ๐จ๐ซ๐ฒ. โค๏ธ
This case is a reminder of why ๐ฐ๐ฎ๐ฟ๐ฒ๐ณ๐๐น ๐๐น๐๐ฟ๐ฎ๐๐ผ๐๐ป๐ฑ ๐ฎ๐๐๐ฒ๐๐๐บ๐ฒ๐ป๐ ๐ฎ๐ป๐ฑ, ๐๐ต๐ฒ๐ป ๐ฎ๐ฝ๐ฝ๐ฟ๐ผ๐ฝ๐ฟ๐ถ๐ฎ๐๐ฒ, ๐ฎ ๐๐ฒ๐ฐ๐ผ๐ป๐ฑ ๐ผ๐ฝ๐ถ๐ป๐ถ๐ผ๐ป ๐ฐ๐ฎ๐ป ๐บ๐ฎ๐ธ๐ฒ ๐๐๐ฐ๐ต ๐ฎ ๐ฝ๐ฟ๐ผ๐ณ๐ผ๐๐ป๐ฑ ๐ฑ๐ถ๐ณ๐ณ๐ฒ๐ฟ๐ฒ๐ป๐ฐ๐ฒ.
This young mother first consulted elsewhere after an ultrasound showed a ๐น๐ฎ๐ฟ๐ด๐ฒ ๐ผ๐๐ฎ๐ฟ๐ถ๐ฎ๐ป ๐๐๐บ๐ผ๐ฟ. At the same time, she was told that she already had an ๐ฎ๐ป๐ฒ๐บ๐ฏ๐ฟ๐๐ผ๐ป๐ถ๐ฐ ๐ฝ๐ฟ๐ฒ๐ด๐ป๐ฎ๐ป๐ฐ๐.
What made the situation particularly difficult was that she had ๐ป๐ผ ๐๐ฎ๐ด๐ถ๐ป๐ฎ๐น ๐ฏ๐น๐ฒ๐ฒ๐ฑ๐ถ๐ป๐ด, ๐ป๐ผ ๐ฎ๐ฏ๐ฑ๐ผ๐บ๐ถ๐ป๐ฎ๐น ๐ฝ๐ฎ๐ถ๐ป, ๐ฎ๐ป๐ฑ ๐ป๐ผ ๐ผ๐๐ต๐ฒ๐ฟ ๐๐๐บ๐ฝ๐๐ผ๐บ๐ suggestive of pregnancy loss.
Hoping that perhaps there was still another possibility, they sought a second opinion at our clinic.
After carefully reviewing the ultrasound, I realized that ๐๐ต๐ฒ ๐ณ๐ถ๐ป๐ฑ๐ถ๐ป๐ด๐ ๐ฎ๐ ๐๐ต๐ฎ๐ ๐ฝ๐ผ๐ถ๐ป๐ ๐ฑ๐ถ๐ฑ ๐ป๐ผ๐ ๐๐ฒ๐ ๐ณ๐๐น๐ณ๐ถ๐น๐น ๐๐ต๐ฒ ๐ฐ๐ฟ๐ถ๐๐ฒ๐ฟ๐ถ๐ฎ ๐ณ๐ผ๐ฟ ๐ฎ ๐ฑ๐ฒ๐ณ๐ถ๐ป๐ถ๐๐ถ๐๐ฒ ๐ฑ๐ถ๐ฎ๐ด๐ป๐ผ๐๐ถ๐ ๐ผ๐ณ ๐ฎ๐ป ๐ฎ๐ป๐ฒ๐บ๐ฏ๐ฟ๐๐ผ๐ป๐ถ๐ฐ ๐ฝ๐ฟ๐ฒ๐ด๐ป๐ฎ๐ป๐ฐ๐. Rather than immediately labeling the pregnancy as a loss, I advised them to repeat the ultrasound after two weeks.
And then came the wonderful news. โค๏ธ
๐ป๐๐๐๐ ๐๐๐ ๐๐ ๐๐๐๐๐๐โ๐๐๐๐ ๐ ๐๐๐๐
๐๐๐๐๐๐๐๐๐.
They were understandably overjoyed. ๐ฅน
But there was still another problem we had to deal with: ๐๐ต๐ฒ ๐น๐ฎ๐ฟ๐ด๐ฒ ๐ผ๐๐ฎ๐ฟ๐ถ๐ฎ๐ป ๐๐๐บ๐ผ๐ฟ.
๐๐ก๐ฒ ๐ซ๐๐ฆ๐จ๐ฏ๐ ๐๐ง ๐จ๐ฏ๐๐ซ๐ข๐๐ง ๐ญ๐ฎ๐ฆ๐จ๐ซ ๐๐ฎ๐ซ๐ข๐ง๐ ๐ฉ๐ซ๐๐ ๐ง๐๐ง๐๐ฒ?
Not every ovarian mass found during pregnancy needs to be removed. Many ovarian cysts are benign and may disappear on their own, so observation with appropriate ultrasound follow-up is often reasonable.
However, surgery may be considered when the mass is:
๐น ๐๐ฎ๐ฟ๐ด๐ฒ ๐ผ๐ฟ ๐ฝ๐ฒ๐ฟ๐๐ถ๐๐๐ฒ๐ป๐, particularly when it is unlikely to resolve spontaneously
๐น ๐๐ผ๐บ๐ฝ๐น๐ฒ๐
๐ผ๐ฟ ๐ต๐ฎ๐ ๐๐น๐๐ฟ๐ฎ๐๐ผ๐๐ป๐ฑ ๐ณ๐ฒ๐ฎ๐๐๐ฟ๐ฒ๐ ๐๐๐๐ฝ๐ถ๐ฐ๐ถ๐ผ๐๐ ๐ณ๐ผ๐ฟ ๐บ๐ฎ๐น๐ถ๐ด๐ป๐ฎ๐ป๐ฐ๐
๐น ๐ฅ๐ฎ๐ฝ๐ถ๐ฑ๐น๐ ๐ด๐ฟ๐ผ๐๐ถ๐ป๐ด
๐น Causing ๐ฝ๐ฎ๐ถ๐ป ๐ผ๐ฟ ๐ผ๐๐ต๐ฒ๐ฟ ๐๐๐บ๐ฝ๐๐ผ๐บ๐
๐น At significant risk for ๐๐ผ๐ฟ๐๐ถ๐ผ๐ป
๐น At risk of ๐ฟ๐๐ฝ๐๐๐ฟ๐ฒ ๐ผ๐ฟ ๐ต๐ฒ๐บ๐ผ๐ฟ๐ฟ๐ต๐ฎ๐ด๐ฒ
๐น Likely to cause ๐ผ๐ฏ๐๐๐ฟ๐๐ฐ๐๐ถ๐ผ๐ป later in pregnancy or during delivery
In this patientโs case, given the size and characteristics of the tumor, we had to carefully weigh the risks of removing it against the risks of leaving it in place.
๐๐ฎ๐ญ ๐ข๐ฌ๐งโ๐ญ ๐ฌ๐ฎ๐ซ๐ ๐๐ซ๐ฒ ๐๐ฎ๐ซ๐ข๐ง๐ ๐ฉ๐ซ๐๐ ๐ง๐๐ง๐๐ฒ ๐๐๐ง๐ ๐๐ซ๐จ๐ฎ๐ฌ?
It certainly carries risksโand this is why the decision is never taken lightly.
๐ฃ๐ผ๐๐ฒ๐ป๐๐ถ๐ฎ๐น ๐ฟ๐ถ๐๐ธ๐ ๐ผ๐ณ ๐ฟ๐ฒ๐บ๐ผ๐๐ถ๐ป๐ด ๐๐ต๐ฒ ๐๐๐บ๐ผ๐ฟ ๐ถ๐ป๐ฐ๐น๐๐ฑ๐ฒ:
โข Bleeding and the need for blood transfusion
โข Infection
โข Injury to surrounding organs
โข Anesthesia-related complications
โข Loss of ovarian tissue or, when unavoidable, the o***y itself
โข Uterine contractions and pregnancy loss
โข Preterm labor or delivery
โข The possibility that the mass could prove malignant and require additional treatment
At the same time, ๐ป๐ผ๐ ๐ฟ๐ฒ๐บ๐ผ๐๐ถ๐ป๐ด ๐ฎ ๐๐ถ๐ด๐ป๐ถ๐ณ๐ถ๐ฐ๐ฎ๐ป๐ ๐ผ๐๐ฎ๐ฟ๐ถ๐ฎ๐ป ๐บ๐ฎ๐๐ ๐ฎ๐น๐๐ผ ๐ฐ๐ฎ๐ฟ๐ฟ๐ถ๐ฒ๐ ๐ฟ๐ถ๐๐ธ๐.
These include:
โข ๐ข๐๐ฎ๐ฟ๐ถ๐ฎ๐ป ๐๐ผ๐ฟ๐๐ถ๐ผ๐ป, which can compromise the blood supply to the o***y and require emergency surgery
โข ๐ง๐๐บ๐ผ๐ฟ ๐ฟ๐๐ฝ๐๐๐ฟ๐ฒ ๐ผ๐ฟ ๐ต๐ฒ๐บ๐ผ๐ฟ๐ฟ๐ต๐ฎ๐ด๐ฒ
โข Increasing pain and acute abdomen
โข ๐ข๐ฏ๐๐๐ฟ๐๐ฐ๐๐ถ๐ผ๐ป ๐ผ๐ณ ๐๐ต๐ฒ ๐ฝ๐ฒ๐น๐๐ถ๐ ๐ผ๐ฟ ๐ฏ๐ถ๐ฟ๐๐ต ๐ฐ๐ฎ๐ป๐ฎ๐น as the pregnancy progresses
โข And, although uncommon, ๐ฑ๐ฒ๐น๐ฎ๐๐ฒ๐ฑ ๐ฑ๐ถ๐ฎ๐ด๐ป๐ผ๐๐ถ๐ ๐ผ๐ณ ๐ฎ๐ป ๐ผ๐๐ฎ๐ฟ๐ถ๐ฎ๐ป ๐บ๐ฎ๐น๐ถ๐ด๐ป๐ฎ๐ป๐ฐ๐
Current guidance emphasizes that medically necessary ๐๐๐ฟ๐ด๐ฒ๐ฟ๐ ๐๐ต๐ผ๐๐น๐ฑ ๐ป๐ผ๐ ๐ฏ๐ฒ ๐๐ถ๐๐ต๐ต๐ฒ๐น๐ฑ ๐๐ถ๐บ๐ฝ๐น๐ ๐ฏ๐ฒ๐ฐ๐ฎ๐๐๐ฒ ๐ฎ ๐ฝ๐ฎ๐๐ถ๐ฒ๐ป๐ ๐ถ๐ ๐ฝ๐ฟ๐ฒ๐ด๐ป๐ฎ๐ป๐. When surgery is necessary, the second trimester is commonly considered a favorable period for planned adnexal surgery, although the exact timing and surgical approach must be individualized.
For this mother, we decided that the potential risks of continuing the pregnancy with this large ovarian mass outweighed the risks of carefully planned surgery.
And so, at ๐ญ๐ฒ ๐๐ฒ๐ฒ๐ธ๐ ๐ผ๐ณ ๐ฝ๐ฟ๐ฒ๐ด๐ป๐ฎ๐ป๐ฐ๐, we removed the tumor.
The photos show the mass immediately after removalโa remarkable reminder of just how much pathology can be present even when a patient feels completely well.
Most importantly, this story isnโt just about removing an ovarian tumor.
Itโs also about ๐ป๐ผ๐ ๐ด๐ถ๐๐ถ๐ป๐ด ๐๐ฝ ๐ผ๐ป ๐ฎ ๐ฝ๐ฟ๐ฒ๐ด๐ป๐ฎ๐ป๐ฐ๐ ๐๐ผ๐ผ ๐ฒ๐ฎ๐ฟ๐น๐, ๐ฐ๐ฎ๐ฟ๐ฒ๐ณ๐๐น๐น๐ ๐ฟ๐ฒ๐๐ถ๐ฒ๐๐ถ๐ป๐ด ๐๐ต๐ฒ ๐ฒ๐๐ถ๐ฑ๐ฒ๐ป๐ฐ๐ฒ, ๐ฎ๐ป๐ฑ ๐ด๐ถ๐๐ถ๐ป๐ด ๐ฝ๐ฎ๐๐ถ๐ฒ๐ป๐๐ ๐๐ต๐ฒ ๐ผ๐ฝ๐ฝ๐ผ๐ฟ๐๐๐ป๐ถ๐๐ ๐๐ผ ๐ธ๐ป๐ผ๐ ๐๐ต๐ฒ ๐๐ฟ๐๐๐ต ๐ฏ๐ฒ๐ณ๐ผ๐ฟ๐ฒ ๐บ๐ฎ๐ธ๐ถ๐ป๐ด ๐น๐ถ๐ณ๐ฒ-๐ฐ๐ต๐ฎ๐ป๐ด๐ถ๐ป๐ด ๐ฑ๐ฒ๐ฐ๐ถ๐๐ถ๐ผ๐ป๐.
From being told that there was no babyโฆ
to seeing a tiny embryo with a strong heartbeatโฆ
to eventually undergoing surgery to protect both mother and pregnancyโ
๐๐ผ๐บ๐ฒ๐๐ถ๐บ๐ฒ๐, ๐บ๐ฒ๐ฑ๐ถ๐ฐ๐ถ๐ป๐ฒ ๐ถ๐ ๐ฎ๐ฏ๐ผ๐๐ ๐๐ฎ๐ธ๐ถ๐ป๐ด ๐ผ๐ป๐ฒ ๐ฐ๐ฎ๐ฟ๐ฒ๐ณ๐๐น ๐๐๐ฒ๐ฝ ๐ฎ๐ ๐ฎ ๐๐ถ๐บ๐ฒ. โค๏ธ
Every ovarian mass in pregnancy is different. Decisions regarding observation versus surgery should be individualized based on ultrasound findings, size, symptoms, gestational age, and the possibility of malignancy, ideally with a multidisciplinary team when indicated.
