| Abstract [eng] |
The incidence of ovarian cysts ranges from 0,3 to 5,4% of all pregnancies, with dermoid cysts accounting for about one-third. While most of the diagnosed cysts are benign and asymptomatic, acute complications such as torsion, rupture, or haemorrhage, although rare, are conditions requiring urgent care. Adnexal torsion due to ovarian cysts most frequently occurs in the first and second trimesters of pregnancy, and torsion in the postpartum period may be caused by physiological uterine involution and by the mobility of the relaxed supporting ligaments. In the case of adnexal torsion, surgical restoration of blood flow is necessary to preserve ovarian function, tissue integrity and the patient’s fertility. Another acute gynaecological pathology may develop if an underlying chronic infection emerges during pregnancy or if the causative agent enters the female reproductive tract during or after delivery: a tubo-ovarian abscess, an infectious, polymicrobial adnexal mass, diagnosed by bacterial growth in urine, cervical and blood cultures. The most common benign tumours of the female reproductive system, uterine myomas, tend to increase in size and degenerate during pregnancy, and may cause acute complications such as torsion of subserosal myoma. Uterine rupture is a rare but serious obstetric complication, threatening to both mother and fetus, more common in patients with a history of one or more uterine surgeries (caesarean section, myomectomy), and especially in those with a short follow-up period of less than 12-24 months after a previous birth. Acute gynaecological diseases during pregnancy and postpartum usually present with one common, non-specific symptom – acute abdominal pain – and therefore differential diagnosis and immediate care are needed to avoid risks to both mother and fetus. Diagnosis is usually based on ultrasound findings and, if necessary, non-contrast magnetic resonance imaging. Laparoscopic surgery is considered the first choice as it involves less pain, quicker recovery, shorter hospitalization and avoids large, unaesthetic scars. The incision site must be chosen according to the duration of the pregnancy, the fundal height to ensure maximum safety. |
