•Abnormal cell free DNA results may indicate occult maternal malignancy.•Cesarean-cytoreductive surgery is feasible even with significant disease burden.•Carboplatin/paclitaxel is first line for epithelial ovarian cancer in pregnancy.
Keywords: Cancer in pregnancy; Cell free DNA screening; Chemotherapy in pregnancy; Fetal aneuploidy screening; Noninvasive prenatal testing; Ovarian cancer.