<prompt> A patient at 5 months pregnancy complains of acute lower abdomen pain. On examination cervical os is closed and there is a tender right adnexal mass. On USG there is a normal intrauterine pregnancy with a 6 cm right ovarian dermoid cyst. Most probable diagnosis is?Inevitable aboionOvarian torsionHemorrhage in cystRed degeneration  <response>: Ovarian masses in pregnancy may be symptomatic or incidentally detected on USG. Here since the ovarian mass is extremely tender, it has probably undergone torsion and a Doppler should be done to diagnose torsion followed by an urgent cystectomy Complications of ovarian masses in pregnancy Rupture Torsion Hemorrhage Obstruction in labour Management 5 cm: follow up 5-10 cm: cystectomy in case of torsion, rupture, suspicion of malignancy, sudden increase in size during follow up 10 cm: elective cystectomy in second trimester NOTE: red degeneration is a complication of fibroid in pregnancy Since cervical os is closed, it is not a case of inevitable aboion 