- Haemorrhagic cysts and cyst rupture can usually be managed expectantly with analgesia and observation
- Any predisposing cause should be addressed, such as factor VIII deficiency causing haemorrhage, or the POP causing recurrent ovarian cysts
- Haemorrhagic cysts should be followed up with a repeat scan after twelve weeks to confirm complete resolution
- Recurrent cyst rupture or haemorrhage should be prevented by suppression of ovulation, usually with the combined oral contraceptive.
- Ultrasound is vital prior to laparoscopy to allow morphological assessment to characterise the nature of any mass and determine the risk of malignancy
- Laparoscopy should be performed for the following indications:
- haemodynamic compromise
- diagnostic uncertainty or likelihood of torsion
- no relief of symptoms within 48 hours of presentation
If laparoscopy is carried out, then aspiration or fenestration of a cyst is not recommended as aspiration of a cyst causing pain has a low sensitivity for detecting malignancy, risks cell dissemination and is associated with cyst recurrence. Ovarian cystectomy is preferred.
Ovarian torsion was traditionally managed with ovarian cystectomy or oophorectomy where the ovary appeared engorged or ischaemic. Evidence now supports conservative management in all cases with laparoscopic detorsion, even where the ovary appears to be infarcted and non-viable. With this technique, ovarian function is preserved in 88–100% of cases.
Rupture of a mucinous cystadenoma can lead to dissemination of cells and the development of the disabling condition of pseudomyxoma peritonei and its complications. While this is extremely rare and can not necessarily be predicted or prevented in the acute gynaecology setting, clinicians should be aware that it is a possibility.
Condous G, Khalid A, Okaro E, Bourne T. Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography. Ultrasound Obstet Gynecol 2004;24:62–6
Yazbek J, Salim R, Woelfer B, Aslam N, Lee CT, Jurkovic D. The value of ultrasound visualization of the ovaries during the routine 11–14 weeks nuchal translucency scan. Eur J Obstet Gynecol Reprod Biol 2007;132:154–8 [Abstract].
Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I; International Ovarian Tumor Analysis (IOTA) Group. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol 2000;16:500–5.