Management of Dermoid Cysts in Pregnancy at a Tertiary Care Centre: A Retrospective Observational Study

Introduction: Ovarian masses are not uncommon in pregnancy. The increased use of Ultrasonography (USG) in recent years has led to the detection of asymptomatic ovarian masses in pregnant women. Dermoid cysts are the most common type of ovarian germ cell tumour in pregnancy. Most of them are asymptomatic and are incidental findings. However, a few can present with complications such as torsion and rupture. The diagnosis and management of dermoid cysts in pregnancy present a clinical dilemma. Aim: To evaluate the management and outcomes of antenatal patients diagnosed with dermoid cysts. Materials and Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at Christian Medical College, Vellore, Tamil Nadu, India, from January 2015 to January 2022. The study included 37 patients, and data regarding the diagnosis of dermoid cysts, their radiological and clinical characteristics, management, and pregnancy outcomes were collected from the electronic database. Descriptive statistics were used for reporting demographic and clinical characteristics. Categorical variables were presented as numbers with percentages, while continuous variables were presented as mean with Standard Deviation (SD) or median with Interquartile Range (IQR). Results: The dermoid cysts ranged in size from 2.2 cm to 30 cm, with a mean size of 7.28 +/- 4.51 cm. A total of 35 (95%) of them were incidentally detected. USG was the imaging modality used for diagnosis and follow-up. Only 30% (11/37) of the patients required surgical intervention during the antenatal period. Torsion was the indication for emergency surgical intervention in 46% (5/11) of cases. Laparoscopy was the preferred approach for surgical intervention in 91% (10/11) of patients. The remaining 70% (26/37) of patients were managed conservatively with serial USG, and no adverse outcomes were reported. Among the patients who underwent caesarean section for obstetric indications, 35% (13/37) also underwent surgical intervention for the dermoid cyst (either cystectomy or oophorectomy) during the same procedure. Conclusion: Antenatal patients diagnosed with dermoid cysts during pregnancy can be managed conservatively with serial USG, with a plan for surgical intervention if needed. In cases where surgical intervention is required, it can be safely performed as a laparoscopic procedure. In case of complications such as torsion, laparoscopy can be performed during pregnancy with appropriate precautionary measures.