Clinical cases/Case 2

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Case presentation
A primigravida visits the antenatal clinic at 39 weeks gestation to discuss her mode of delivery. She is 31 years old, had conceived soon after stopping combined oral contraceptive pills, had a routine ultrasound scan in the first trimester with no findings, and has reassuring medical, surgical and family histories.

Her pregnancy has been uneventful, with one minor exception. Between 34 and 39 weeks, her midwife repeatedly found the baby to have an unstable transverse lie, with the head palpable in various locations of the abdomen. Ultrasound scans by an obstetric ultrasonographer had not revealed a cause.

On abdominal examination, the baby's head can be moved easily, and the option of external cephalic version with artificial rupture of membranes is discussed with the woman. To see whether this woman already has a ripe cervix, a vaginal examination is performed.

On vaginal examination, the patient is found to have a large, soft pelvic mass. A targeted transabdominal ultrasound scan reveals a heterogenous transparent intrapelvic mass of 9 x 10 centimeters, posteriolateral to the right of the cervix, with an inlying cystic structure and no associated ascites. Doppler flow analysis shows no feeding vessels.

Case discussion
Review questions
 * What are the possible differential diagnoses of ovarian cysts?
 * What is the appropriate management of ovarian cysts in pregnancy?

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