The management of ovarian pathology in pregnancy

The extensive use of ultrasound in early pregnancy populations has led to more ovarian lesions being diagnosed incidentally in asymptomatic gravid women. The majority of these lesions are physiological in nature and tend to resolve spontaneously as the pregnancy progresses. Expectant management or a “watch and wait” approach is the benchmark standard of care for a woman with an ovarian mass diagnosed during pregnancy. This approach assumes the woman is relatively asymptomatic, and the likelihood of malignancy is negligible. The prevalence of malignancy in pregnancy is rare indeed, i.e. 1 in 15,000–32,000. It is the discriminatory ability of ultrasound, in experienced hands, to distinguish between benign and malignant ovarian lesions that allow appropriate triaging during pregnancy. Discriminating benign from malignant masses is crucial not only to optimize the management of malignancies, but also to avoid unnecessary intervention that may adversely affect maternal or foetal outcomes. This review will focus on the management of ovarian masses in pregnancy.