Placenta vs Umbilical Cord

Placenta vs Umbilical Cord

 

Umbilical cord and placenta together forms the lifeline between mother and fetus. These two structures are extremely important to ensure the survival of the fetus inside a mother’s womb. Placenta and umbilical cord are considered as a characteristic feature of the largest group of mammals, called ‘placental mammals’. With the help of these special structures, females can carry their developing young, internally in a uterus and nourish them until the delivery.

Placenta

Placenta is a specialized disk shaped organ that attached to the uterine wall and is connected to the fetus via the umbilical cord. It contains a fetal component, the chorionic frondosum, and a maternal component, the deciduas basalis. Placenta brings maternal blood into close contact with the fetal blood and serves as the provisional lungs, intestine, and kidneys of the fetus, without mixing maternal and fetal blood. It is also known as an organ of interchange between mother and fetus.

Placenta can produce pregnancy related hormones including human chronic gonadotropin (hCG), estrogen, and progesterone. Human chronic gonadotropin maintains the mother’s corpus luteum, while estrogen and progesterone maintain the uterine endometrium. Placenta is also important in exchanging gases and detoxifying toxic molecules, thereby protecting the fetus from toxic substances.

Umbilical Cord

Umbilical cord is the birth cord, which contains two arteries and one vein. Food, oxygen, and other chemicals are transported to the fetus through the arteries, and wastes produce in the fetus are returned through the vein. One end of umbilical cord is attached to the fetus at its navel while the other end is attached to mother at the placenta; hence it makes the connection between mother and fetus.

In humans, umbilical cord starts to develop at 5 weeks after conception and develop progressively until 28 week of pregnancy. Normally it reaches average length of 55 to 60cm and allows baby to move around without causing any damage to the cord or the placenta.

What is the difference between Placenta and Umbilical Cord?

• Placenta is connected to the fetus by umbilical cord.
• Umbilical cord evolved from the allantois whereas most of the placenta evolved from the chorion.
• Placenta produces hormones, while umbilical cord does not produce any hormone.
• In placenta, maternal blood and fetal blood come into close contact, and nutrients are transferred from maternal blood to fetal blood, while waste products are transferred from fetal blood to maternal blood. Umbilical cord carries fetal blood to placenta, while it carries maternal blood to fetus.
• Placenta is the place where nutrients and wastes are exchanged between mother and fetus, whereas umbilical cord serves as the link between fetus and placenta.
• Umbilical cord is a narrow tube-like structure, while placenta is a disk- shaped organ.
• Placenta is attached to the uterine wall, whereas two ends of umbilical cord are attached to placenta and navel of fetus.

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Diffrance between Progesterone and Estrogen ?

Progesterone vs Estrogen

A Regulatory chemical produced by an endocrine gland or an organ, that travels through the blood stream to affect specific cells or an organ in a different place in the body is defined as a hormone. Progesterone and estrogen are the two types of female sex hormones that the ovaries begin to secrete at puberty and the placenta secretes during pregnancy. Basically these hormones are responsible for producing sexual characteristics, developing reproductive system, and maintaining pregnancy in females. Both these hormones are steroid compounds and are transported in the blood as small, hydrophobic molecules by binding to a serum globulin. Like all other steroid hormone, estrogen and progesterone readily diffuse across the cell membrane.

Estrogen

There are six different estrogens in the female body, but only three of them are in substantial amounts. They are estradiol, estrone, and estriol. Estrogen promotes and maintains female organs and secondary sexual characteristics in females. It also enhances protein anabolism, promotes thinning of cervical mucus, inhibits ovulation, and prevents postpartum breast pain. In addition, estrogen maintains the elasticity of the urogenital structure and stimulates growth of axillary and pubic hair and pigmentation of the nipple and genitals. Estrogen also helps indirectly to strengthen the skeleton by conserving calcium and phosphorus and encourage bone formation.

Estradiol is the most important estrogen hormone secreted by the ovaries, while estriol is the most abundant of three other types. Estrone is produced only during the pregnant period. During pregnancy, placenta produces estrone and maintains the uterine lining, which is helpful in protecting and nourishing the developing embryo.

Progesterone

Progesterone belongs to the group of progestin and involves in the female menstruation cycle, pregnancy, and embryogenesis in humans. It also helps to maintain the secondary characteristics of female. Progesterone is a steroid hormone, which is carried by blood to target cells in the body and stored in adipose tissues, in the body. Progesterone is a hydrophobic molecule and is composed of four cyclic interconnected hydrocarbons. It is mainly produced in ovaries, adrenal glands, and in the placenta (during pregnancy).

What is the difference between Progesterone and Estrogen?

• During the period of pregnancy, estrogen develops the mammary ductal system while, progesterone improves the lobular and alveolar growth.
• Estrogen stimulates formation, development and maintenance of the female secondary characteristics, whereas progesterone helps to maintain female secondary characteristics.
• Progesterone belongs to hormone group called progestin, while estrogen is considered as a hormone group. There are six types of hormones that come under the group estrogen.
• During pregnancy, placenta cannot synthesize estrogen until the development of the fetus to the point that it releases DHEA (dehydroepiandrosterone) into blood. In contrast, the placenta can synthesize progesterone soon after implantation.
                             

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Detailed about Thyroid gland and its function?

Detailed about Thyroid gland and its function?

Thyroid function tests are blood tests which help to check the function of the thyroid gland. They are mainly used to detect hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid).

Note: the information below is a general guide only. The arrangements, and the way tests are performed, may vary between different hospitals. Always follow the instructions given by your doctor or local hospital.

What is a thyroid function test?

Thyroid function tests are blood tests that check the levels of the hormones (chemicals) made by the thyroid gland. Some thyroid function tests also check the level of a hormone made by the pituitary gland in the brain, which acts on the thyroid gland.

What is the thyroid?

The thyroid is a gland found in the neck. Its main function is to make hormones.
Hormones are chemicals which are released into the bloodstream. They act as messengers, affecting cells and tissues in distant parts of your body. Thyroid hormones affect the body's metabolic rate and the levels of certain minerals in the blood.

What does the thyroid do?

The thyroid makes three hormones that it secretes into the bloodstream. Two of these hormones, called thyroxine (T4) and triiodothyronine (T3), increase your body's metabolic rate. The other hormone helps to control the amount of calcium in the blood.
In order to make T3 and T4, the thyroid gland needs iodine, a substance found in the food we eat. T4 is called this because it contains four atoms of iodine. T3 contains three atoms of iodine. In the cells and tissues of the body most T4 is converted to T3. T3 is the more active hormone; it influences the activity of all the cells and tissues of your body.

How does the thyroid work?

The main job of the thyroid gland is to produce hormones T4 and T3. To do this the thyroid gland has to take a form of iodine from the bloodstream into the thyroid gland itself. This substance then undergoes a number of different chemical reactions which result in the production of T3 and T4.
The activity of the thyroid is controlled by hormones produced by two parts of the brain, the hypothalamus and the pituitary. The hypothalamus receives input from the body about the state of many different bodily functions. When the hypothalamus senses levels of T3 and T4 are low, or that the body's metabolic rate is low, it releases a hormone called thyrotropin-releasing hormone (TRH). TRH travels to the pituitary via the connecting blood vessels. TRH stimulates the pituitary to secrete thyroid-stimulating hormone (TSH).
TSH is released from the pituitary into the bloodstream and travels to the thyroid gland. Here TSH causes cells within the thyroid to make more T3 and T4. T3 and T4 are then released into the bloodstream where they increase metabolic activity in the body's cells.

High levels of T3 stop the hypothalamus and pituitary from secreting more of their hormones. In turn this stops the thyroid producing T3 and T4. This system ensures that T3 and T4 should only be made when their levels are too low.

How do thyroid function tests work?

There are several different types of thyroid function tests which may be carried out. Interpreting all the different tests is complicated as there are various conditions which can change the level of these hormones. A rough guide to the different types of tests and their interpretation is given below. However, your doctor or specialist doctor should explain individual test results.
Usually the first test to check thyroid function measures the levels of TSH in your blood. In people with hypothyroidism (underactive thyroid) the amount of TSH will usually be high. This is usually because the thyroid is not making enough T3 to stop the pituitary producing TSH. If the level of TSH is high, you will usually have further tests to check the levels of T3 and T4 in the blood.
In people with hyperthyroidism (overactive thyroid) the level of TSH will usually be low. This is usually because the thyroid gland is making too much of its hormones. When levels of T3 and T4 are high, the pituitary is 'turned off' and the amount of TSH produced is less. If you are found to have low levels of TSH you may have some more blood tests to check the levels of T3 and T4 in the blood. These tests may help doctors to find a specific cause of the low TSH.

What are thyroid function tests used for?

Thyroid function tests are usually done to find out whether the thyroid gland is working properly. . Thyroid function tests can also be done to:

• Monitor treatment with thyroid replacement medicine for people who have hypothyroidism.
• Check thyroid gland function in people who are being treated for hyperthyroidism.
• Screen newborn babies for inherited problems with the thyroid.

What happens during a thyroid function test?

A thyroid function test is a simple blood test. The blood sample is then sent to the laboratory for analysis, and the results are sent back to the doctor who asked for the tests.

What should I do to prepare for a thyroid function test?

Thyroid function tests usually require very little preparation. Tell your doctor if you are taking any medication as some drugs can alter the test results and how they are interpreted. It is also important to mention if you have had any X-ray tests that have used a special contrast dye as this may contain iodine which can affect the results. Levels of thyroid hormones also change in pregnancy, so tell your doctor if you are pregnant when the test is taken.

                                                  

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What is cystic fibrosis?

What is cystic fibrosis?

Cystic fibrosis, or 'mucoviscidosis', is a hereditary disease. A defective gene results in an inability to transport salt in certain kinds of cells in the lungs and in the pancreas. It is the most common hereditary disease in Western Europe.

Why does a person get cystic fibrosis?

Cystic fibrosis is an 'autosomal recessive' disease, which means that both parents have a gene defect that they pass on to their offspring. But the child will have cystic fibosis only if it inherits both of the defective copies of the gene. There is a 1:4 chance of this happening.
In one out of four chances the child will inherit a normal copy of the gene and be unaffected by cystic fibrosis. There is a one in two chance that the child will be a carrier for the CF gene.
Cystic fibrosis is due to a faulty gene which blocks the normal workings of a protein, allowing too much salt and not enough fluid into cells.
This severely thickens the mucus in the respiratory passages which makes the respiratory passages more susceptible to bacterial infection, most frequently Staphylococcus, Pseudomonas and Burkholderia cepacia complex.

How can I tell if I have cystic fibrosis?

The symptoms are usually noticeable in the first year of life. If cystic fibrosis is suspected, the diagnosis can be confirmed through a special sweat test. The GP can then make a referral to a cystic fibrosis centre at a hospital.
In the lungs, the disease results in repeated cases of pneumonia and breathing difficulties. The pancreas becomes less able to produce digestive juices, which may result in weight loss and greasy diarrhoea .
The disease increases the salt content in the patient's sweat. At high temperatures this may result in the patient losing too much salt and suffering heatstroke .

What can I do?

If somebody is expecting to be a parent, they should check if there have been any cases of cystic fibrosis in their family. If there is, they can talk to their doctor about being referred to a genetic counsellor.
The counsellor will be able to assess the chances of the baby having the disease, at which point tests may be able to be offered to confirm or not the diagnosis in the unborn baby (chorionic villus sampling).
Someone with cystic fibrosis must avoid unnecessarily straining their lungs, for instance by smoking. Lung exercises with a special mask (PEP) are often useful.

Future prospects

Previously, the prognosis for cystic fibrosis sufferers was very gloomy. But the treatment is getting better and now there is an 80 per cent chance that a child with cystic fibrosis will live for over 40 years.
Genetic treatment holds considerable promise over the next decade but it will be in the future before this becomes any kind of mainstream treatment.

How is cystic fibrosis treated?

The treatment aims to maximise the lung function for as along as possible.
Common treatments include lung physiotherapy as well, as antibiotics to minimise the risk of lung infections. Complications within the pancreas can be managed by controlling the patient's diet, and providing supplements of pancreatic enzymes (eg Creon) to add to food. Diabetes mellitus ('sugar diabetes') may complicate the course of adult CF, needing treatment with insulin injections. As a result of cystic fibrosis, some patients may also suffer asthma, which can be alleviated by asthma inhalers . A lung or a lung and heart transplant may be necessary if the lung function deteriorates very significantly.

                                     

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Anaemia during pregnancy ?

What is anaemia?

Anaemia is a lack of red blood cells, which can lead to a lack of oxygen-carrying ability, causing unusual tiredness.
The deficiency occurs either through the reduced production or an increased loss of red blood cells.
These cells are manufactured in the bone marrow and have a life expectancy of approximately four months.
To produce red blood cells, the body needs (among other things) iron , vitamin B12 and folic acid. If there is a lack of one or more of these ingredients, anaemia will develop.

What are red blood cells?

Red blood cells are the cells that circulate in the blood plasma (fluid) and give blood its red colour.
Through its pumping action, the heart propels the blood around the body through the arteries.
The red blood cells obtain oxygen in the lungs and carry it to all the body's cells.
The cells use the oxygen to fuel the combustion (burning) of sugar and fat, which produces the body's energy.


During this process, called oxidation, carbon dioxide is created as a waste product.
It binds itself to the red blood cells that have delivered their load of oxygen.
The carbon dioxide is then transported via the blood in the veins back to the lungs where it is exchanged for fresh oxygen by breathing.

Causes of anaemia during pregnancy

Women often become anaemic during pregnancy because the demand for iron and other vitamins is increased.
The mother must increase her production of red blood cells and, in addition, the foetus and placenta need their own supply of iron, which can only be obtained from the mother.
In order to have enough red blood cells for the foetus, the body starts to produce more red blood cells and plasma.
It has been calculated that the blood volume increases approximately 50 per cent during the pregnancy, although the plasma amount is disproportionately greater.
This causes a dilution of the blood, making the haemoglobin concentration fall.
This is a normal process, with the haemoglobin concentration at its lowest between weeks 25 and 30.
The pregnant woman may need additional iron supplementation, and a blood test called serum ferritin is the best way of monitoring this.
Other causes include:
a diet low in iron. Vegetarians, and dieters in particular, should make sure their diet provides them with enough iron lack of folic acid in the diet, or more rarely, a lack of vitamin B12 loss of blood due to bleeding from haemorrhoids (piles) or stomach ulcers anaemia is more common in women who have pregnancies close together and also in women carrying twins or triplets.

What are the symptoms of anaemia during pregnancy?

If the woman is otherwise healthy, she will rarely have any symptoms of anaemia unless her haemoglobin (red pigment) is below 8g/dl.
The first symptoms will be tiredness and paleness. Palpitations – the awareness of the heartbeat, breathlessness and dizziness can occur, though they are unusual. If the anaemia is severe (less than 6g of haemoglobin per decilitre of blood), it may cause chest pain (angina) or headaches .

What can be done to avoid anaemia during pregnancy?

Be sure to get a varied diet. If planning a pregnancy, talk to a doctor or midwife about food and supplements – if possible, before becoming pregnant. Good sources of iron are beef, wholemeal bread and cereals, eggs, spinach and dried fruit. Supplementing the diet with iron , vitamins and especially folic acid. Taking 400 micrograms folic acid when pregnant is important to reduce the risk of having child with spina bifida. A doctor may advise taking combined iron and folic acid supplements before becoming pregnant. To absorb the maximum amount of iron from the diet, it will help to also eat a diet rich in vitamin C. Raw vegetables, potatoes, lemon, lime and oranges are all good sources of vitamin C. Foods rich in folic acid include beans, muesli, broccoli, beef, Brussels sprouts and asparagus. A pregnant woman should take notice of her body's signals and consult a doctor if any symptoms occur. It is now routine to recommend to women planning a pregnancy to take a folic acid supplement for the first 12 weeks of pregnancy and preferably starting before conception. This reduces the risk of spinal cord defects (spina bifida) developing in the foetus.

How does a doctor diagnose anaemia during pregnancy?

Apart from the clinical symptoms, anaemia is usually detected during antenatal screening. Blood tests are usually done at the first consultation, and again in the second half of pregnancy.
A description of the red blood cells – their different form and colour will be included in the result of the blood test.
In women of Afro-Caribbean or Mediterranean origin, additional tests are performed to screen for genetic causes of anaemia, namely sickle cell anaemia and thalassaemia.
Possible complications of anaemia
Difficulty in breathing, palpitations and angina . Severe anaemia due to loss of blood after the delivery. If this occurs, then a woman may be advised to have a blood transfusion.

How will a doctor treat anaemia during pregnancy?

A doctor will examine the expectant mother and prescribe any necessary treatment for anaemia, such as vitamins or minerals .
Iron tablets can often cause constipation or diarrhoea and some women simply cannot take them.
Side-effects on the gut can be resolved by taking the iron with or after food or by starting with a low dose and increasing gradually – talk to your doctor about this.

Iron supplements for non-anaemic pregnant women
Anaemia in women is often associated with low birth weight and preterm births, but that does not mean that women should be taking iron pills, or any vitamin pills indiscriminately, to prevent poor pregnancy outcomes.
Women who are not suffering from anaemia should ensure that they receive proper advice on diet and nutrition from their doctors and midwives.
Iron supplements may have a harmful effect on women who do not need them in the first place.

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How body temperature increases in FEVER ?

What is fever ?

Whenever any bacteria or virus inters into our body our body temperature increases from normal is called FEVER.

Normal Body Temperature

.37 degree celcius and in fahrenhiet is 98.6 degree.

In our bloodstreams pyrogens are flow. pyrogens are chemical whenvever pyrogens are come in contact with any bacteria or virus then body temperature increases. as you know that hypothalamus is the incharge of regulation of body temperature. so these pyrogens by bloodstream reach to the hypothalamus in brain and attach to the some receptors of hypothalamus and give the signal to increase the temperature.

Pyrogens are of different types but Interleukin-1 is common pyrogens. IL-1 is produced by white blood cells called macrophage cells. when these interleukin come in contact with any bacteria or virus . interleukin has many purpose first is that to activate other white blood cells called T helper cells. One of to increase the temperature of body by attaching receptors of hypothalmus in brain.

Interleukin increase the temperature becoz its wants to make unfavorable condition for particular bacteria or virus and destroy them.

One of the most common debate is that increase of temperature during FEVER is good or not ?

The reality is that increase of temperature is good for patients of FEVER.

Diagnosis

Increase of temperature from normal. Normal temperature is

37 degree celcius and in fahrenhiet is 98.6 degree.

Treatment

Aspirin or Paracetamol for example, will reduce fever; but if the fever is actually helping rid the body of infection, then lowering it might not be a good idea. On the other hand, people sometimes die from fever. Right now the general medical consensus falls on the "reduce the fever" side of the fence.

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Fully described Amoebic dysentery and its treatment?

What is amoebic dysentery?

There are several different species of amoebae, but the most dangerous, such as Entamoeba histolytica, live predominantly in tropical areas.
These species are able to burrow through the intestinal wall and spread through the bloodstream to infect other organs, such as the liver, lungs and brain.
Amoebic dysentery (amoebiasis) is an infection of the intestine (gut) caused by an amoeba called Entamoeba histolytica that, among other things, can cause severe diarrhoea with blood.
But it may cause milder chronic symptoms of:

• frequent loose stools
• abdominal pain
• cramps
• fatigue
• intermittent consitipation. 
• diarrhoea with abdominal swelling
• flatulence.

Amoebae are parasites that are found in contaminated food or drink. They enter the body through the mouth when the contaminated food or drink is swallowed.
The amoebae are then able to move through the digestive system and take up residence in the intestine and cause an infection.

How do you get amoebic dysentery?

Entamoeba histolytica can exist in two forms in contaminated food and drink:

• as free amoebae (known as 'trophozoites')
• as infective cysts, which are a group of amoebae surrounded by a protective wall, that have been passed (excreted) in the carrier's faeces (human or animal).

If you swallow contaminated food that contains the free amoebae (trophozoites), hardly anything is likely to happen because they usually die in the stomach on account of its acidity.
On the other hand, cysts are particularly resistant to the acidic contents of the stomach, and food contaminated with cysts represents a genuine risk of infection.
When the cysts reach the intestine of another person, the individual amoebae are released from the cysts and are able to cause infection.
Amoebic dysentery is passed on by careless or negligent hygiene, where contaminated food and drink is consumed without adequate heat treatment.
Salads washed with contaminated water are a common method of spread.

What does amoebic dysentery feel like?

Amoebic dysentery may not demonstrate any symptoms for long periods of time (months, even years). But infected individuals still excrete cysts and, consequently, infect their surroundings.
When the amoebae attack, they damage the walls of the large intestine – causing ulceration and subsequent bleeding.
The milder symptoms of this are:

• stomach cramps (colic)
• painful passage of stools (tenesmus)
• bloody, slimy diarrhoea that's often foul smelling.

But the course of the disease can become complicated and alter radically if the amoebae break through the intestinal wall and its lining (peritoneum), causing peritonitis (inflammation of the peritoneum).
The amoebae may be transported via the blood to the liver and other organs and usually do NOT give rise to a high temperature (this can be useful ie bloody diarrhoea with a fever suggests a bacterial infection) and a seriously debilitated condition.
In the long term, the amoebae can, among other things, form enormous cysts in the liver and other organs, which sometimes may only be discovered on investigation by a doctor for other conditions, such as unexplained weight loss or illness.

What can you do to help yourself?

In practice, the only way to avoid infection with amoebic cysts is to ensure that everything you eat or drink has been washed or sterilised properly and cooked thoroughly.
Drinking water can be made safe in two ways:

• by boiling it for 10 to 15 minutes (a little longer at high altitudes), and then cooling it rapidly and keeping it covered
• by adding water-purifying tablets and then leaving the mixture to stand for at least 15 minutes before use
• by using a filtration device such as Aquapure Traveller (combined ceramic and chemical filters) or Lifesaver system.

Chemical methods of sterilisation do not, however, guarantee complete destruction of all possible harmful organisms.
Foods to avoid include salads, unpeeled fruit and ice cream.
Ice cubes may also have been made with contaminated water. So, avoid having drinks that contain ice cubes, unless you're certain that the water used to make them has been sterilised.

Diagnosis

Anyone who develops bloody diarrhoea should see a doctor as soon as possible and ensure that they tell the doctor they have been travelling in the tropics, as amoebic dysentery doesn't normally occur in the UK.
In the presence of the classic symptoms of amoebic dysentery, the diagnosis can often be made by means of a stool analysis.
Bloody diarrhoea is seen in many other illnesses, but in tropical areas the diagnosis will typically be either amoebic dysentery or shigellosis (bacillary dysentery which is caused by bacteria and more likely associated with a fever).

Treatment

Amoebic dysentery is treated with metronidazole or tinadazole.
A problem arises in that some of the parasites will not respond to treatment and the medicines required to totally get rid of the disease after the above treatment are not readily available (ie Paromomycin o diloxanide furoater).
Complications, such as perforation of the intestinal wall or the presence of abscesses within the body's organs, require specialist hospital treatment.
In an emergency for instance, if you have bloody diarrhoea and are on holiday in the tropics and cannot get medical help: you can treat yourself with metronidazole, eg two 400mg tablets, three times a day for five days. This is the dose for adults who are neither pregnant nor breastfeeding.
It's important to avoid drinking alcohol during treatment. Even if you have to treat yourself, it's important to see a doctor to ensure that the treatment has been truly effective.
UK General Practitioners are not supposed to provide NHS prescriptions for travellers away for longer than three months.
As metronidazole requires a prescription, you could ask your own doctor or travel clinic to write a private prescription in advance if you know that you will be travelling to remote tropical areas where access to a doctor or hospital may be difficult.
Such prescriptions need to be issued privately, ie the cost of the drug has to be paid in full to the pharmacist.                                     

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Detailed about Ovarian Cysts ?

What are ovarian cysts?

A woman's ovaries contain numerous immature eggs some of which mature and develop over the course of a woman's life until the menopause.
In normal women an egg is produced every month. The egg finds its way to the Fallopian tube, where it may be fertilised if sperm are present.
Sometimes cysts may develop. These are often filled with liquid and are almost always benign.
Cysts can occur from one month to the next and may result from an egg which fails to mature. They may burst and thus disappear on their own.
If you have a simple cyst, there's a 60 per cent chance it will disappear after 12 weeks.
If they're over 6cm in size, they are unlikely to disappear naturally and removal should be considered.

What are the symptoms of ovarian cysts?

Most ovarian cysts produce no symptoms and women are unaware of their presence.
However, if a cyst ruptures, twists, or if there is bleeding into the middle of the cyst, then one-sided lower abdominal pain is possible.
Sometimes the cyst can be large enough to put pressure on the bladder (making you feel as they you want to pass urine all the time) or bowel, they may be disturbed during intercourse causing discomfort or pain during penetration.
Ovarian cysts can be associated with other conditions – such as cancer, endometriosis , fertility drugs or early pregnancy.
The risk of ovarian cancer is dependant on the womans age being rare under the age of 40.
The likelihood of cancer is dependant on a number of factors, a combination being more significant than a single feature.

How are ovarian cysts diagnosed?

Ovarian cysts are usually diagnosed on a pelvic ultrasound, but may also be picked up on CT or MRI scan.
If they are large, they may be felt at the time of a pelvic[internal] examination.

What will the doctor do?

Depending on the severity of symptoms and what the risk factors are will determine the management options.

• If the cyst is likely to be benign, asymptomatic and less than 4cm the doctor will probably reassure you and rescan in 12 weeks.
• If over 6cm removal is usually recommended.
• If more than 4 and less than 6cm, a repeat ultrasound in 4 to 6 weeks to check for a change in size.

The doctor may advise removing the cyst. Cysts are usually removed using laproscopic (keyhole) surgery, although not all cysts are suitable for removal in this way.

Ovarian cysts in postmenopausal women

It is recommended that ovarian cysts in postmenopausal women should be assessed using CA125 and transvaginal grey scale sonography. There is no routine role yet for Doppler, MRI, CT or PET.
In order to triage women, an estimate needs to be made as to the risk that the ovarian cyst is malignant. This needs to be done using tests that are easily available in routine gynaecological practice.
At present, these tests are serum CA125 measurement and ultrasound. Serum CA125 is well established, being raised in over 80 per cent of ovarian cancer cases and, if a cut-off of 30 u/ml is used.
Ovarian cysts should normally be assessed using transvaginal ultrasound because this appears to provide more detail and hence offers greater sensitivity than the transabdominal method.
The roles of other imaging modalities, such as magnetic resonance imaging (MRI), computed tomography (CT) and positron emission tomography (PET), in the diagnosis of ovarian cancer have yet to be clearly established.
It's recommended that a 'risk of malignancy index’ should be used to select those women who require primary surgery in a cancer centre by a gynaecological oncologist.
The best prognosis for women with ovarian cancer is offered if a laparotomy and full staging procedure is carried out by a trained gynaecological oncologist.
Most cysts will be benign, gynaecologists in units at more local level will perform the majority of surgery. It should be appreciated, however, that no currently available tests are perfect, offering 100 per cent specificity and sensitivity. Ultrasound often fails to differentiate between benign and malignant lesions, and serum CA125 levels, although raised in over 80 per cent of ovarian cancers, is raised in only 50 per cent of stage I cases.
In addition, levels can be raised in many other malignancies and in benign conditions, including benign cysts and endometriosis.
Those women who are at low risk of malignancy also need to be triaged into those where the risk of malignancy is sufficiently low to allow conservative management, and those who still require intervention of some form.

Non-invasive treatment

Simple, unilateral, unilocular ovarian cysts, less than 5 cm in diameter, have a low risk of malignancy. It is recommended that, in the presence of a normal serum CA125 levels, they be managed conservatively.
Numerous studies have looked at the risk of malignancy in ovarian cysts, comparing ultrasound morphology with either histology at subsequent surgery or by close follow up of those women managed conservatively.
The risk of malignancy in these studies of cysts that are less than 5cm, unilateral, unilocular and echo-free with no solid parts or papillary formations is less than 1 per cent. In addition, more than 50 per cent of these cysts will resolve spontaneously within three months.
It's reasonable to manage these cysts conservatively, with a follow-up ultrasound scan for cysts of 2 to 5cm, a reasonable interval being four months. This, of course, depends upon the views and symptoms of the woman and on the gynaecologist’s clinical assessment.

Surgical treatment

Those women who do not fit the above criteria for non-invasive treatment should be offered surgical treatment.
Aspiration is not recommended for the management of ovarian cysts in postmenopausal women. Cytological examination of ovarian cyst fluid is poor at distinguishing between benign and malignant tumours.
In addition, there's a risk of cyst rupture and, if the cyst is malignant, there is some evidence that cyst rupture during surgery has an unfavourable impact on disease free survival.
Aspiration, therefore, has no role in the management of asymptomatic ovarian cysts in postmenopausal women.

Laparoscopy

The laparoscopic management of benign adnexal masses is well established. However, when managing ovarian cysts in postmenopausal women, it should be remembered that the main reason for operating is to exclude an ovarian malignancy.
If an ovarian malignancy is present then the appropriate management in the postmenopausal woman is to perform a laparotomy and a total abdominal hysterectomy, bilateral salpingo-oophorectomy and full staging procedure.
The laparoscopic approach should therefore be reserved for those women who are not eligible for non-invasive treatment but still have a relatively low risk of malignancy.
Women who are at high risk of malignancy, as calculated using the risk of malignancy index, are likely to need a laparotomy and full staging procedure as their primary surgery.
It's recommended that laparoscopic management of ovarian cysts in postmenopausal women should involve oophorectomy (usually bilateral) rather than cystectomy.
In a postmenopausal woman, the appropriate laparoscopic treatment for an ovarian cyst, which is not suitable for conservative management, is oophorectomy, with removal of the ovary intact in a bag without cyst rupture into the peritoneal cavity.
There is the risk of cyst rupture during cystectomy and, as described above, cyst rupture into the peritoneal cavity may have an unfavourable impact on disease-free survival in the small proportion of cases with an ovarian cancer.
If a malignancy is revealed during laparoscopy or subsequent histology, it's recommended that the woman is referred to a cancer centre for further treatment.
If an ovarian cancer is discovered at surgery or on histology, a subsequent full staging procedure is likely to be required. A rapid referral to a cancer centre is recommended for those women who are found to have an ovarian malignancy.
Secondary surgery at a centre should be performed as quickly as feasible.
All ovarian cysts that are suspicious of malignancy in a postmenopausal woman, as indicated by a high risk of malignancy index, clinical suspicion or findings at laparoscopy, are likely to require a full laparotomy and staging procedure.

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