The ovaries not only provide seeds for race reproduction -eggs, but also secrete female hormones to maintain women’s characteristics and pregnancy.Moreover, the ovaries are still when they are working with illness, such as ovarian cysts with pregnancy.The treatment method is more difficult, and pregnant women and fetuses need to be considered.Therefore, it is recommended to prepare women who are pregnant to do a comprehensive examination before pregnancy.
There are not many ovarian tumors and pregnancy at the same time. About 100 to 8,000 times of pregnancy occur, most of which are benign tumors, accounting for 95%to 98%.
The reason why it is valued is because it is more confused, which is about the mother and child.Bed tumors with ovarian tumors with mature cystic teena and slurry (or mucop) cystic tumors are the most.
It can be said that the ovary ovulation process that controls women once a month is one of the culprits that destroy the ovaries, and pregnancy is one of the best protection for the ovaries.In the months of pregnancy, ovulation stopped ovulation and restrained.Therefore, the pregnancy process not only reproduces offspring, but also a natural enemy of ovarian tumors, but it is obviously ridiculous to prevent cancer through pregnancy.
Conversely, ovarian tumors are also enemies of pregnancy. Ovarian tumors can affect pregnancy in the early, middle and late stages of pregnancy.
During early pregnancy, the tumor may be embedded in the pelvic cavity, which makes the uterine position abnormally, or stimulates the uterine contraction, thereby inducing natural abortion;
During the middle pregnancy, the uterus increases, and the ovarian tumor of the activity is prone to reversing. The severe abdominal pain and the surgical operation that need to be performed after reversing can also cause abortion or premature birth;
During the late pregnancy, if the tumor is large and the uterus is squeezed, the fetal position may be abnormal, so that the fetal head cannot enter the pelvic cavity; if the tumor position is low, it may block the birth canal and cause difficulty in giving birth.
The physiological changes of the body of the pregnancy can also affect ovarian tumors and develop towards unfavorable situations.
Pelvic congestion during pregnancy, increased ovarian blood supply, and tumors can grow quickly;
During pregnancy, the increase in the volume of the uterus and the change of the position can turn ovarian tumors to reverse;
The squeezing during childbirth may cause tumor rupture.
In addition, the increase in uterus during pregnancy often makes ovarian tumors difficult to find, delays the diagnosis and treatment of tumors.
As a result, when dealing with pregnancy and cancer, I often develop dilemma.I hope that the pregnancy can be successful and the treatment of tumors will not be delayed:
Does pregnancy need to be terminated?
Continuing pregnancy to the fetus can affect the prognosis of the tumor?
The effect of tumor on the fetus?
What harm will the treatment of tumors bring to the fetus?
The possibility of future pregnancy after this pregnancy end?
When is the best operation?
These problems need to be negotiated with the patients and their families, weigh the advantages and disadvantages, and decide to deal with the plan.
First of all, pay attention to the pelvic blocks found during pregnancy, and do not delay the diagnosis of malignant tumors.
Specific principles:
For ovarian blocks that are merged during pregnancy, if the diameter is less than 5 cm, and the examination is gradually narrowed, it can be considered as a physiological cyst and does not need to be treated.Especially for the elderly patients who have been pregnant, because a large amount of progesterone secreted during pregnancy can inhibit their growth.
If the diameter of the mass is more than 5 cm, laparoscopic surgery or caesarean section should be performed around 16 weeks of pregnancy, regardless of whether there are complications such as twisting.Only when surgery is performed in a timely manner can we avoid complications and find malignant situations in time.It is generally believed that during the second trimester of surgery, compared with the reduction of miscarriage during early pregnancy, the impact of anesthetic drugs on fetal development is also small.
If the swelling material is rigid, nodular, fixed or bilaterality, especially if it cannot be removed, it should be a caesarean operation.Such as tumor to reverse, ruptured or infected, or is accompanied by acute abdominal pain, nausea and vomiting, and even shock, it also needs to be surgery immediately.
Secondly, if you are decided to surgery during pregnancy, the pelvic cavity and abdominal cavity are needed during surgery.
For the initial judgment of the removed campaign, it is preliminary to determine whether it is malignant, and send frozen slices of rapid pathology to determine the benign and malignant tumor, comprehensively investigate, remove suspicious tissues to send rapid pathological examinations, determine preliminary diagnosis and tissue categories. This is a doctor.The matter of our affairs is more described.
Finally, it is necessary to do a comprehensive examination before pregnancy for women with a pregnancy plan.
The project includes at least pelvic ultrasonic examination. If necessary, you can take blood to check the tumor table marker (refer to some special substances that increase the concentration of blood in the blood after the tumor, such as CA125, CA199, CEA, AFP, etc.).
Generally speaking, if there is no pregnancy, ovarian cysts with a diameter of more than 5 cm need to be treated.However, for women who are preparing to get pregnant, the standards are slightly stricter, and they are tentatively set for 4 cm. Even if the content of the mass is liquid (called a cyst), surgery should be surgery. Laparoscopic minimally invasive surgery should be the best.
However, even if the diameter of the mass is less than 4 cm, those with solid ingredients, those who do not disappear for multiple examinations, should be treated before pregnancy to avoid danger of tumor growing up after pregnancy.
In short, checking ovarian tumors before pregnancy, dismantling timing bombs, safe and happy crossing during pregnancy is the best policy.
Author of this article: Tan Xianjie, Beijing Union Hospital
Copyright Statement: This article is an original article of Dr. Gao Ge’s Chief physician. Please indicate the source "Dr. Gao Ge" for reprinting.
Picture source: pixabay
WeChat search and follow the subscription number of the "Gao Sing Famous Doctor", and read the popular science article of the Chief Doctors of the Three Hospital every day.
WeChat search and pay attention to the service number of "Dr. Gao Ge", and make free appointment for the director of the three hospitals and the medical consultation for free.
