Ovarian Lutein Cysts in Pregnancy

Three cases of theca lutein cysts associated with nonmolar pregnancies are presented and the literature reviewed. Of the 29 cases discussed, 7 occurred in patients with Rh sensitization, 6 in patients with multiple pregnancies and 16 in patients with apparently normal single pregnancies. The diagnosis was made either during cesarean section, performed according to obstetric indications, during obstructed labor due to pelvic mass or, in some patients, with acute abdomen, pelvic pain and pelvic mass in the first or second trimester of pregnancy, during laparotomy. Excluding the 7 cases of hydrops due to Rh sensitization, 3 abnormal fetuses were found among the 22 pregnancies. Misinterpretation at laparotomy or erroneous histopathologic interpretations resulted in unnecessary major surgery in 10 of the 26 cases reviewed. When theca lutein cyst is diagnosed during pregnancy or labor, conservative treatment, including minimal intervention with the cystic ovaries, is advocated. The etiologic role of high levels of human chorionic gonadotrophin (HCG) in these cases is considered.