Women who present with lower abdominal pain or unilateral iliac fossa pain need to have a TVS in order to exclude an ectopic pregnancy. In the situation where an intrauterine pregnancy is confirmed, an ovarian cyst may be the cause of the abdominal pain. In a recent study in our unit, we reported that the prevalence of ovarian cysts of >25 mm in the firsttrimester population studied was 5.4%; the vast majority of these were incidental findings.25 The
vast majority of these ovarian cysts resolved spontaneously and expectant management was found to be safe.
Most ovarian cysts in early pregnancy are corpora lutea (Figure 3.5) and these can cause abdominal pain if they undergo haemorrhage, rupture or torsion. The first two complications tend to be self-limiting; however the latter can be catastrophic resulting in ovarian infarction and loss of the ovary if not diagnosed promptly. The diagnosis of ovarian torsion is a clinical one and ultrasound is not always decisive. The management and characterization of ovarian cysts in early pregnancy is covered in Chapter 15. Interestingly, in early pregnancy, localizing the corpus luteum can be a useful guide when looking for an ectopic pregnancy with TVS. It will be on the ipsilateral side in 70-85% of cases.7,26,27
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