Labor may mask a symptom of the rupture of ovarian endometrial cyst: a case report

Kino, Tamina; Obata, Soichiro; Osanai, Nana; Hashimoto, A; Okada, Yukiko; Aoki, Shigeru; Miyagi, Etsuko

doi:10.1002/ccr3.1554

Cited by 3 publications

(1 citation statement)

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“…The causes and mechanisms of rupture of endometriomas reportedly include adhesion to surrounding tissues, the size increase of a cyst due to bleeding inside the cyst causing rupture of a cyst, softening of the tissue resulting in collapse of the cyst wall due to stromal decidualization, and reduced pelvic cavity as the pregnant uterus occupies the pelvic space where ovarian cysts are present. 13,27 In our study, the risk factors for cyst rupture were adhesion to the surroundings (in all cases), an increase in size of the cyst (Case 3 and 4), a large size with a diameter of ≥6 cm (Case 3 and 4), vulnerability of the cyst wall by infection (Case 1), and compression due to the enlarged uterus in the late pregnancy (Case 2, 3, and 4). During pregnancy, predisposing factors for cyst rupture are increased compared to that in nonpregnancy, and that may be the reason for cyst rupture occurred in 2.8% of pregnant women.…”

Section: Discussionmentioning

confidence: 61%

Characteristics of ovarian endometrioma during pregnancy

Takami

Kajiyama

Miyagi

et al. 2021

J of Obstet and Gynaecol

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Aim: During pregnancy, the ovarian endometrioma generally decreases in size and occasionally ruptures. We evaluated (1) whether and how ovarian-endometrioma size changes from the first trimester to the postdelivery period, and (2) the type of endometrioma more likely to rupture during pregnancy. Methods: During an 18-year period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018), ultrasound in the first trimester revealed ovarian endometrioma in 149 pregnant women at our tertiary institute. Among these, we subjected 138 endometriomas in 145 patients to expectant management (wait-and-watch approach during pregnancy). We compared the cyst sizes in the first trimester and the postdelivery period, and defined a >1 cm diameter size-change as a significant increase/decrease. We analyzed four patients with rupture and characterized the predictors of rupture. Results: A comparison of cyst sizes in the first trimester and the postdelivery period revealed that the size of 94 (68%), 37 (27%), and 7 ovaries (5.0%), respectively, decreased, remained unchanged, and increased; in 56 ovaries (40%), apparent cysts were no longer present. Of the 145 patients, four (2.8%) required emergency surgery for cyst rupture. Adhesion to the surroundings, an increase in cyst size, large size (diameter of ≥6 cm), and compression due to the enlarged uterus in late pregnancy were factors clinically related to rupture.Conclusions: Approximately two-thirds of ovarian endometriomas decreased in size during pregnancy (40% disappeared), 27% remained unchanged, and only 5% increased in size. However, 2.8% of pregnant women with endometrial cysts experienced rupture. We characterized risk factors for rupture; however, clinical application requires further evaluation.

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Section: Discussionmentioning

confidence: 61%