The incidence of ovarian torsion rises fivefold during pregnancy. The most common cause of ovarian torsion in pregnancy is a corpus luteum cyst. In the case of ovarian torsion, the definite diagnosis is made preferentially via laparoscopy. Pregnant patients undergoing surgery may have an increased risk of preterm delivery and intrauterine growth restriction. If an ovarian cyst is present, a cystectomy should be attempted to preserve the ovarian function and future fertility. Several studies have shown the safety of laparoscopy in pregnancy. The surgeon should use the following principles – after the first trimester, the lateral recumbent position is advised to reduce pressure on the vena cava and maintain adequate venous return. The open Hasson technique is preferred for initial entry because it provides optimal visualization. Maternal CO2 monitoring during insufflation is recommended due to the potential concern of fetal acidosis. If the fetus is considered previable, it is generally sufficient to ascertain the fetal heart rate with Doppler before and after the procedure. Preoperative pneumatic compression devices and early postoperative ambulation are encouraged. If less than 12 weeks gestation, progesterone therapy should be initiated after removal of the corpus luteum.

The establishment of ultrasonography in daily gynaecological and obstetric practice has increased the rate of diagnosis of ovarian cysts amongst pregnant women. Both assessment and management of ovarian cysts in pregnancy can be challenging. Although most cysts are functional in nature and a conservative approach can be employed, a small proportion will carry some malignant potential. Identifying which cysts can be safely managed expectantly and which necessitate surgical intervention, investigating possible cyst accidents, deciding on the timing and nature of intervention (fine needle aspiration versus cystectomy or even oophorectomy), the surgical approach (laparotomy versus laparoscopy) and balancing the risks and benefits for the mother and the fetus are just a few examples of the dilemmas that need to be addressed, ideally within a multidisciplinary team-based environment.