1. Ovarian Cyst And Its Complication
Dr. Miada Mahmoud Rady
EMS /473
Gynecological Emergencies 3

2. Ovarian Cyst
Definition : An ovarian cyst is a fluid-filled sac that forms on or within an ovary.
Types :
Functional : normal .
Follicular .
Corpus luteum .
PCOD.

3. Types of Ovarian Cyst Functional cyst : The most common type of cyst .
During the menstrual cycle, the ovaries form tiny sacs (cysts) to hold the oocytes Once the oocyte matures, the sac breaks to releases the oocyte and then disappears .
May be the cause of abdominal heaviness and pain female experience during menstruation.
Functional cysts are usually harmless, rarely cause pain, and often disappear within two or three menstrual cycles

4. Types of Ovarian Cyst Follicular cyst :
Result from failure of the follicle to rupture and release the oocyte.
As result oocytes grows and turns into a follicle.
Normally disappears within 1 to 3 months.

5. Types of Ovarian Cyst Corpus luteum cyst :
It occurs as result of sealing the site of oocyte release from follicle.
As result the corpus luteum grows and starts to accumulate fluid forming cyst .
Corpus luteum cyst secretes estrogen and progesterone.
Fertility drugs can increase the chances of corpus luteum cysts developing.

6. Corpus luteum cyst

7. Bilateral Huge Corpus Luteum Cyst As Result of Fertility Drugs

8. Types of Ovarian Cyst Polycystic ovarian disease ( PCOD):
Result from repeated and excessive cyst formation with failure of ova release .
Exact etiology is unknown.
It is spectrum of both clinical and morphological abnormalities in women with an endocrine dysfunction mainly abnormal androgen production and metabolism.

9. Polycystic ovarian disease ( PCOD)
Pathophysiology :
Increased androgen and decreased estrogen leading to menstrual irregularities acne and excessive hair growth.
Insulin resistance leading to diabetes and obesity.
Increased incidence of hypertension and ischemic heart disease.

10. Polycystic ovarian disease ( PCOD)
Clinical presentation :
Absent or irregular menstruation .
Infertility .
Hirsuitism .
Acne .
Obesity .
Insulin resistant , metabolic syndrome and D.M.

11. PCOD

13. After Drilling
Before Drilling

14. Clinical presentation of uncomplicated ovarian cyst
Dull, achy pain in the lower back and thighs.
Abdominal pain or pressure.
Nausea and vomiting.
Breast tenderness.
Abnormal bleeding and painful menstruation.
Painful intercourse.

16. OVARIAN CYST COMPLICATION
Rupture .
Torsion.
Abscess Formation.
Complicated ovarian cyst is a true gynecological emergency.

17. Rupture of ovarian cyst
Leads to Internal Hemorrhage And Acute Abdomen.
Signs and symptoms include:
Sharp lower abdominal pain.
Abdominal distention , tenderness and rigidity.
Dizziness , Weakness and Syncopal episode.

18. Ovarian torsion Abdominal Pain
Occurs when the cyst reaches a considerable size causing the ovary to twist which impair its blood supply .
Treatment : surgery .
Clinical presentation :
Abdominal Pain

19. Criteria Of The Pain of Ovarian Torsion
Onset : sudden .
Provocation: walking .
Quality : sharp.
Radiation and reference : radiate to the back or thigh
Severity : sever .
Site : unilateral lower abdominal pain .
Associated symptoms : nausea and vomiting.

20. Abscess Formation Called Tubo-ovarian abscess . Most common causes :
Gonorrheal PID.
Appendicitis .
Diverticulitis.
Fallopian tubes or ovaries become blocked by an infectious mass, which grows and forms an abscess.

21. Tuboovarian abscess Symptoms Signs Fever . Headache . Anorexia .
Malaise .
Nausea and vomiting .
Abdominal pain .
Abdominal tenderness .
Rebound tenderness .
Rigidity.
Guarding .
Abdominal distension.
Absent intestinal sounds .

22. Management of complicated ovarian cyst
Ensure patent airway and anticipate vomiting so keep patient in left lateral position.
High flow oxygen .
Continuously monitor vital signs and evaluate the presence of shock.
Give analgesic if allowed
Transport rapidly and inform hospital about your diagnosis and patient condition.

23. Prolapsed uterus
Definition : drop of the uterus from its normal position into vagina .
Etiology : occurs due to weakness of muscles and ligaments holding uterus in its position which may be due to :
Age .
Child birth .
Obesity .
Low estrogen levels .

24. Clinical presentation
Vaginal , pelvic pain and Low back pain,.
Dysuria and Incontinence.
Infection and bad smelling discharge.
Varying degrees of feeling like something is falling out of or bulging from their vagina.

25. Management Prehospital treatment is limited to:
Pain management and Treatment for shock if present
Do not replace any tissue and Cover with warm, moist dressings.
Do not let the patient walk.
Definitive treatment includes : devices to hold the organs in place or surgery.

26. Any questions?? Home work
Enumerate complication of ovarian cyst and mention the clinical presentation and management of one.
Any questions??