pregnancy present many therapeutic challenges as a result of ever present conflict between optimal maternal therapy (surgical resection) and the well being of the fetus (preterm labor) [1]. At the University of California, San Diego, we recently encountered a 31-year-old, previously healthy female at 22 weeks gestation, who presented with rapidly increasing abdominal size and 2 week history of abdominal pain. An obstetric ultrasound demonstrated a single intrauterine pregnancy (size compatible with dates) coexisting with a large mass in the abdomen (originating from the right ovary), which measured 27.0·27.0·11.0 cm (Figs. 1, 2). Surgical resection (cystectomy and right ovariectomy) under general anesthesia (rapid sequence induction with cricoid pressure) was necessary due to a rapid tumor growth. Pathologic evaluation was reported as benign mucinous cystadenoma. Neither intranor postoperative maternal and fetal complications were reported. However, it should be remembered (and emphasized) that perioperative challenges in these parturients may include supine positioning-related aortocaval compression syndrome (commonly under-appreciated outside of the Labor and Delivery suite) leading to severe hypotension at induction of general anesthesia [2].