HEALTH LIBRARY

OVARIAN CYSTS: WHAT YOU NEED TO KNOW
1. What is an ovarian cyst?

The ovaries are a pair of oval-shaped organs, about 3-4 centimeters in length, found on both sides of the womb. They are part of the female reproductive system, producing female hormones & eggs. A cyst is a fluid-filled space, lined by a thin wall, that can sometimes occur in the ovaries. Cysts vary in size, from tiny ones measuring a few millimeters to large growths that can be as big as a melon.

2. Are all cysts the same? What are the various types of ovarian cyst?
There are many different types of ovarian cyst. These include:
  • Functional (or physiological) cysts
    These cysts form, & then shrink or disappear during various stages of the menstrual cycle. Most of them do not cause symptoms & treatment is usually not required.
  • Bleeding (haemorrhagic) cysts
    These occur when there is bleeding into a cyst. The patient will complain of abdominal pain.
  • Dermoid cysts
    A dermoid cyst, or teratoma, is usually benign (non-cancerous) & contains a variety of tissue, such as hair & bone.
  • Endometriotic cysts These occur when the lining of the womb gets shed during menses & some of the tissue gets implanted around the ovary. Over time, this forms a collection of blood. The old blood gives it a chocolate-like appearance.
  • Other benign cysts (e.g. cystadenoma)
  • Polycystic ovaries
    Tiny cysts are found on the outer rim of the ovary – this may be associated with hormonal problems, irregular menses, fertility issues & other symptoms.
  • Cancerous cysts
3. What are the symptoms of ovarian cysts?
Many women with ovarian cysts do not experience symptoms, & are only diagnosed during a routine medical examination. Those who have symptoms may complain of:
  • Lower abdominal pain or fullness
  • Menstrual pain
  • Symptoms related to pressure on the surrounding organs, such as difficulty urinating
  • Painful intercourse
  • Irregular menses
Complications
The majority of cysts are benign (non-cancerous). However, all cysts could potentially grow & give rise to problems, such as pressure on the surrounding organs & becoming cancerous. Cysts can sometimes bleed, rupture (& spill their contents into the abdominal cavity) or undergo torsion, or twisting. All these could cause severe pelvic pain.

How can I find out if I have an ovarian cyst?
Most patients with ovarian cysts have no symptoms & are only diagnosed during a routine medical check. Ovarian cysts are often picked up using various imaging techniques, such as ultrasound & CT scans. Your doctor may order blood tests to get an idea whether the cyst could potentially be cancerous.

Treatment
Your doctor may advise close observation if you are young, have no symptoms, & the cyst looks to be entirely fluid-filled (no solid areas) on the scan. In this situation, you will be asked to have a repeat scan in 2-3 months. If, however, the cyst persists or enlarges at the repeat scan, or if it looks suspicious, surgery may be advised. Postmenopausal women & women with symptoms, such as pain, may also be candidates for surgery. Surgery can take the form of laparoscopy (key-hole surgery) or laparotomy (open surgery). Laparoscopy involves the insertion of a telescope through the navel whilst you are under general anaesthesia. The doctor then visualizes & removes the cyst. Laparoscopy can be done using one (single-port laparoscopy) to four small incisions on the abdomen. Laparotomy (open surgery) is done if the cyst is large or if the suspicion for cancer is high.
A HEALTHY LIFESTYLE AND A SUCCESSFUL PREGANCY: WHAT YOU NEED TO KNOW
Rest and Sleep
During pregnancy, the growing foetus puts new demands on your body. You may feel unusually tired during early pregnancy and as your pregnancy advances. Get at least 8 hours of sleep every night. Whenever you feel tired at work, find a quiet room, sit down, and raise your legs on a footstool or support. At home, your routine housework and family commitments will have to be adjusted.
  1. How much rest is necessary?
    During the day time, you should take a break and rest for at least an hour every day, or alternatively split it into two ½ hour periods.

  2. What positions should I rest in?
    • Lie flat on the bed with a pillow under your head. Your feet may be raised higher than the head with one or more pillows.
    • Lie on your side with a pillow under your head. The lower leg is stretched behind you; the upper leg is bent at the hip and the knee over a pillow. There may or may not be a pillow supporting your upper arm.
    • Sit in a leaning back position with a small cushion behind your head and in the small of your back, making sure that the whole length of your legs is supported.
Nutrition
As your foetus is growing, it is important that you have a healthy, well-balanced diet so that both you and your baby get sufficient nutrients and energy.

Exercise
Exercise is acceptable during the course of a normal pregnancy. Always consult your doctor before embarking on an exercise programme in pregnancy. If there are medical or obstetric complications in the pregnancy, exercise should be reduced or avoided.
  1. What types of exercises are safe?
    • Walking
    • Jogging – this should be done in moderation.
    • Swimming – this is an excellent form of exercise for pregnant women. Provided the water is not too hot or cold. Avoid scuba diving.
    • Cycling / stationary cycling.
    • Low-impact aerobics.

  2. What types of exercise should be avoided?
    • Activities which require sudden and forceful contact, for example, soccer, boxing and hockey should be avoided.
    • Exercises that require jumping and jarring motions or rapid changes in direction, for example, tennis and basketball should be avoided.
    • Water sports like water-skiing and scuba diving are considered unsafe in pregnancy.
    • Sports that involve continuous jumps, for example volleyball and horseback riding should be avoided.
    • After the fourth month of pregnancy, exercises done in the supine position (lying flat on the back) for a long duration should be avoided.

  3. What measures and precautions should I take?
    Moderation is always the best policy.
    • Exercising three to four time a week for 20 minutes to half an hour each time is enough to maintain fitness and well-being during pregnancy.
    • Avoid sudden spurts of heavy exercise followed by long periods of inactivity.
    • Drink sufficient water (about seven to eight glasses each day) and consume enough calories to meet the needs of your pregnancy as well as your exercise programme.
    • Wear comfortable, well-cushioned shoes that give your body good support.
    • Spend about 10 minutes doing low resistance exercises as part of a warm-up before each exercise.
    • Exercise on a safe, firm surface such as a wooden floor or tightly carpeted surface to reduce the risk of injury.
    • Exercise with smooth movements; avoid bouncing or jerking.
    • When exercising, try to time your pulse; do not allow your heart rate to go above 140 beats a minute.
    • If you are getting up from the floor after an exercise, do so slowly to avoid dizziness and a sudden drop in blood pressure.

  4. What are the warning signs to stop exercising?
    You should stop exercising and consult your doctor if you have any of the following symptoms:
    • Vaginal bleeding.
    • Abdominal or back pain.
    • Palpitations or heart rate above 140 beats per minute.
    • Chest pain.
    • Breathlessness.
    • Headache.
    • Loss of muscle control.
    • Dizziness.
    • Nausea.
    • Absence of foetal movement.

Posture
Correct posture and proper body mechanics are important prerequisites for a comfortable pregnancy
  1. How should I be standing?
    • When standing, sway slightly forward to find a comfortable position with your body balanced over your hips and feet.
    • Try avoid standing for long stretches of time, especially in the later stages of pregnancy.

  2. How should I be sitting?
    • Sit well back on your chair with your weight taken on your buttocks and not on the end of your spine.
    • Support your lower back with a small cushion.
    • Move and rotate your ankle frequently during sitting to promote blood circulation in your legs.

  3. How should I be lifting things?
    • Never carry anything heavier than you can manage with ease.
    • Get close to the object you intend to carry.
    • When reaching the object, with your feet apart, bend the knees and hips and not the waist.
    • Always keep your back as straight as possible. Hold on to the object, keeping it close to your body.
    • Turn by transferring your weight from one foot to the other, not by twisting your back. Stand by slowly straightening your legs.

  4. How should I be getting up?
    • Avoid getting up by raising your body using the abdominal muscle.
    • Get up from the bed by slowly turning to your side, bringing your arm over and swinging your legs over the edge of the bed to stand.

Clothing
  • Clothing should be comfortable and loose.
  • Belts or constricting garments should not be worn around the waist as this interferes with blood circulation.
  • Maternity brassieres or brassieres of an appropriate size should be worn to give your breasts firm support and to protect the nipples.
  • Should wear low-heeled, well-fitting shoes for comfort and support. These are less likely to cause a fall or backache.

Travel
Travelling (by car, ship, train or plane) does not adversely affect a pregnancy, but being far away from a doctor may be hazardous should any emergencies arise. Therefore, you should avoid long journeys and travels to distant places. This is especially so if you have any of the following:
  • History of spontaneous miscarriage.
  • History of preterm labour.
  • Vaginal bleeding in the present pregnancy.
  • Multiple pregnancy.
  • Any serious medical problem that requires special medication and medical care.

A few simple precautions and measures, travelling can be comfortable and safe:
  • During travelling, take frequent breaks where possible to relieve fatigue and discomfort. Try to walk for a few minutes every 1 to 2 hours as this helps to decrease leg swelling and improve blood circulation.
  • Try to rest or sleep often so that you will be less tired or irritated.
  • Wear loose clothing and comfortable shoes.
  • Drink plenty of fluids and eat well-balanced nutritious meals.
  • Many women suffer from morning sickness in the first trimester and this can be aggravated by travelling. Ideally, start the journey a few hours after eating. Take light, regular meals with a lot of fluids, if you are going on a long journey,
  • Though travelling can cause stomach upset or disrupt your sleep, do not take any prescription or over-the-counter medications without consulting your doctor first.
  • Seek medical attention immediately if you have any of the following symptoms – abdominal pain, dizziness, vaginal bleeding or watery discharge flowing from the vagina.
  • When travelling in a car, you should wear a seat belt. The most desirable protection would be a 3-point restraint. The seat belt should go above or below the womb, and not over it. If you are wearing a diagonal shoulder strap, this should pass over the shoulder between the breasts, above the womb without restraining the neck region. The lap strap should be worn low to restrain the hip bones. Never place the lap strap over the abdomen as this can cause injuries in a crash.
  • When travelling in a plane, get an aisle seat so that you can get up and walk around or go to the lavatory easily. Ask for extra pillows to make your seat comfortable.
Work
  • Women who have sedentary jobs may continue to work throughout the pregnancy.
  • Strenuous jobs that require heavy lifting, prolonged standing or walking, climbing, long hours, rotating shifts, and other efforts that require stamina and agility are not advised.
  • You may stop working if you have a medical condition, a multiple pregnancy, a history of premature labour, or threatened miscarriage in the current pregnancy.
  • Do try to take short breaks during the working hours to rest or sleep.
  • Towards the end of pregnancy, the increased weight and enlarged abdomen may cause you to lose balance. Precautions have to be taken to prevent you from falling during work.
Chemicals
  • Certain chemicals, for example, arsenic, aluminium, alkylating agents, benzene, carbon monoxide, chlorinated hydrocarbons, and mercury compounds should be avoided as they may be harmful to the foetus.
  • Healthcare workers should avoid substances like anaesthetic gases, ethylene oxide and formaldehyde (used for sterilising of medical equipment), and chemo-therapeutic drugs.
Ionizing Radiation
  • Flight attendants may run the risk of excessive exposure to radiation from the sun if their flights often bring them to very high altitudes.
  • Healthcare workers may be exposed to X-rays used in the diagnosis and treatment of diseases.
Infectious Diseases
Precautions should be exercised to prevent the transmission of infectious diseases during pregnancy.
  • Healthcare workers – needle stick injuries may result in the transmission of illness such as hepatitis and AIDS.
  • Teachers and social workers may come into contact with children and may be exposed to potentially dangerous infections like chicken pox and rubella.
Some Harmful Agents And Their Effects On Your Baby
As all major organs of the baby are formed during the first 3 months, make sure that your lifestyle involves nothing that might harm the baby.

Smoking
Smoking is harmful for you and your baby. It increases the incidence of low birth weight babies and may be associated with foetal death or damage in the uterus resulting in miscarriage or still birth.

There are also long-term effects – children of smoking mothers tend to have slower growth and development.

Passive smoking is harmful too – try to avoid other people’s “second-hand smoke”.

Many harmful substances can be found in cigarette smoke:
  • Nicotine – it travels to your foetus’ blood vessels and can cause constriction so that less oxygen reaches your foetus.
  • Tar
  • Carbon monoxide – it travels to your foetus’ blood and decrease the amount of oxygen reaching the cells.
Alcohol
Alcohol has a deleterious effect on your foetus.
  • Pregnant women who drink heavily have greater risk of miscarriage.
  • Heavy maternal alcohol consumption is also associated with the “foetal alcohol syndrome”, in which the baby may have growth retardation, characteristic facial deformities and nervous system involvement.
Caffeine
Caffeine is found in coffee, tea, cola, cocoa, certain soft drinks, and some over-the-counter drugs. Studies have shown an increased incidence of small babies, stillbirths, premature labour and miscarriage in women who take a lot of caffeine.

Drugs
Most of the drugs that you take can have harmful or unknown effects on the baby, so avoid taking medications unless it is prescribed by a doctor who knows that you are pregnant. This includes self-medication for minor complaints such as cold cures, pain killers, antacids, and laxatives.

It is important to keep your doctor informed if you have had a history of allergy to a particular medication. Always remember the name of the medication you are allergic to, the conditions under which it was taken, and the allergic reactions you developing after taking it.

Household Agents
Insecticides and herbicides some chemical insecticides have been associated with miscarriage and birth defects. Avoid using pesticides if you are pregnant. Remember to wash your fruits and vegetables thoroughly to remove pesticides.

Cleaning products
  • Avoid inhaling substances that have strong odour or fumes.
  • Always read product labels – do not use those which have warnings about toxicity.
  • When handling household chemicals, wear rubber gloves. These will help prevent the absorption of toxic substances through the skin.
TYPES OF MATERNITY SCANS: WHAT YOU NEED TO KNOW
1) First Trimester Pregnancy Scans: 0 to 12 weeks
Early Pregnancy Viability or Dating Scan
An Early Pregnancy Viability Scan is helpful if you feel a bit worried or want to make sure that all is well with your baby. It is important to have this scan if you have had vaginal bleeding or suspect an ectopic pregnancy.

When is the scan performed?
Viability scans are performed at 6 weeks – 12 weeks of pregnancy. If you have a concern about a possible ectopic pregnancy, this scan can be conducted at 5 weeks – 7 weeks.

What will I learn from the scan?
A Viability Scan is also known as a Dating Scan. It is used to determine the age of the pregnancy; and how many babies there are. It is able to confirm the presence of a heartbeat, and indicate the size of the sac or the foetus. It can also show if there is any internal bleeding which may be significant and which may need to be carefully monitored. At this stage the obstetrician or sonographer will be able to confirm that the sac is in the uterus.

How is the scan performed and how long does it take? If you are having a Viability Scan it can be performed trans-abdominally (through the tummy). If you are having the scan at 6-7 weeks because of a concern about a possible ectopic pregnancy, it may need to be performed trans-vaginally. In either case, the scan usually takes about 5-10 minutes.

Do I need to prepare for the scan? It is advisable to come to the appointment with a full bladder as this will improve the visibility of the scan when performed through the tummy.

Nuchal Translucency Scan or 11 to 14 Week Scan
A Nuchal Translucency Scan confirms that there is a heartbeat, and the number of foetuses. The baby’s head, trunk, arms, legs, hands and feet can be seen and your obstetrician will also look at the placenta, amniotic fluid and umbilical cord.

When is the scan performed? This scan is performed between 11 and nearly 14 weeks of pregnancy.

What will I learn from the scan? A Nuchal Translucency Scan can be used as part of a screen for Down Syndrome.

How is the scan performed and how long does it take? The Nuchal Translucency Scan is performed trans-abdominally (through the tummy) and usually takes 20 to 30 minutes to perform.

Do I need to prepare for the scan? There is no special preparation needed for this scan and there is no need for a full bladder.

2) Second Trimester Pregnancy Scans: 13 to 28 weeks
When is the scan performed?
14 weeks – 22 weeks

What will I learn from the scan?
The baby’s head, abdomen, and leg length will be measured. The placenta can be located and the amniotic fluid and umbilical cord assessed

How is the scan performed and how long does it take?
This scan is performed through the tummy (a trans-abdominal scan) and usually takes 15-20 minutes.

Do I need to prepare for the scan?
You do not need to have a full bladder for this scan and no special preparation is needed.

Fetal Anomaly Scan 21 - 22 Week Scan
It is also known as a 21 Week Scan, an Anomaly Scan is a chance for your baby’s development and well-being to be assessed in greater detail.

When is the scan performed?
An Anomaly Scan can be performed from 18 weeks but some doctors advise scans between 22-24 weeks. This is because often at that time the images of the baby are clearer.

What will I learn from the scan?
With an Anomaly Scan, your baby’s anatomy is examined in detail. Measurements will be made of the head, brain, abdomen and legs. Your baby’s heart, brain, spine, bowel and limbs are checked to detect any abnormalities. This can never completely guarantee that the baby will be normal, but it gives very strong reassurance. The placenta, amniotic fluid and the umbilical cord are also all checked

In order to examine internal organs properly, the Anomaly Scan is performed in 2D. However, this is the time when you are able to get a much clearer picture of your baby, making it an emotional and exciting scan for many parents.

How is the scan performed and how long does it take?
The Anomaly Scan is performed trans abdominally (through the tummy) and usually takes about 30 minutes. However, because there are so many parts of your baby’s anatomy to be checked, it may be necessary for you to change positions or get up and walk around a little, in order to encourage the baby to move into a more favourable position.

Do I need to prepare for the scan?
Some obstetricians will ask you to drink fluid beforehand.

3) Third Trimester Scans: 28 to 40 weeks
Wellbeing Scan or Fetal Growth Scan
The purpose of this scan is to check that the baby is growing well and that the pregnancy is developing normally.

You may want to have this scan if
  • your baby has been moving less,
  • you have had unusual tummy pains, light bleeding
  • you have had some kind of accident (for example on the road or in a fall).
  • you have had pregnancy complications or problems in a previous pregnancy.
When is the scan performed?
The Scan is performed between 28 and 40 weeks of pregnancy. Some obstetrician advise that it is useful to have such a scan at about 36 weeks.

What will I learn from the scan?
In this Scan, your baby’s measurements will be taken to make sure growth is proceeding normally. The growth of the baby will be assessed by measuring the head, abdomen and femur length (thigh bone). This way your obstetrician can estimate the baby’s weight and give you an idea as to how big it will be at birth. The appearance and position of the placenta is also checked, and the amniotic fluid around the baby is measured. The flow of blood through the umbilical cord is assessed using Doppler ultrasound. Your obstetrician will look at how well the baby is moving and can tell you the sex of your baby if you wish.

How is the scan performed and how long does it take?
The Wellbeing Scan is performed trans abdominally (through the tummy). It usually takes about 30 minutes and is conducted in 2D.

Do I need to prepare for the scan?
No special preparation is required – it’s not necessary to have a full bladder.

Make an Appointment

Acufem Women’s Specialist Services
Suite 05-38 Gleneagles Hospital (Annex Block)
6A Napier Road, Singapore 258500

E enquiry@acumed.com.sg
T (65) 6474 3821
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