Management of a Huge Ovarian Cyst in Pregnancy at the Douala General Hospital, Cameroon: A Case Report and Review of the Literature

Background: Ovarian cysts in pregnancy are common and are usually small benign functional cysts (corpus luteum and theca-lutein cysts) that usually resolve spontaneously between 14 and 16 weeks of gestation. However, large ovarian cysts are rare in pregnancy, with an incidence of 0.2% - 2%, and most of them are benign. The first-line diagnostic modality is ultrasonography. Complications of ovarian cysts in pregnancy include miscarriage, ovarian torsion, cyst rupture, etc. Laparotomy is the treatment modality commonly used in our setting, and histopathologic diagnosis is important for the prognosis of the treatment. Case Presentation: MC is a 32-year-old G3P2002 married housewife of the Bakweri tribe who was referred to our department because of progressive abdominal discomfort and shortness of breath for 1 month’s duration. Her medical history is consistent with two normal vaginal deliveries at term and the use of implants (for contraception) until one month prior to the index pregnancy. Her booking visit was at 16 weeks gestation at a primary (missionary) healthcare facility, and she underwent ultrasonography and was diagnosed with a singleton viable intrauterine pregnancy and a simple septate cystic mass measuring 17 cm situated on top of the uterus, appearing to originate from the left ovary. She was referred to seek the expertise of an obstetrician-gynecologist, but she came to our department at 35 weeks gestation and underwent cesarean birth at 37 weeks gestation. In the pathological review, serous cystadenoma was diagnosed, and there were no positive findings in peritoneal cytology. Conclusion: The ultrasonographic diagnosis of the huge ovarian cyst in the index case was after 16 weeks gestation because of her late booking visit at 16 weeks gestation. The index case deferred referral to the obstetrician because of a lack of finances, came to our department at 35 weeks gestation because of abdominal pain that may have resulted from a torsion of the ovarian cyst, and underwent cesarean birth because of malpresentation and fear of cyst rupture during labor. We recommend cesarean section in such cases because of suboptimal antenatal care uptake and histopathology of the specimen to exclude malignancy.