[Ultrasonographic diagnosis and prenatal management of fetal ovarian cysts]

Abstract

Objective of the study: To evaluate the outcome of fetal ovarian cysts in relation to their ultrasonic appearance and size. To define, on that basis, the contribution of intrauterine aspiration.

Material and methods: Retrospective study of all ovarian fetal cysts detected by prenatal ultrasound examination (n = 25) during a 4 year period. All these cysts were followed during pregnancy and after delivery until spontaneous or surgical resolution.

Results: At the time of prenatal sonographic detection at the mean gestational age of 32 1/2 weeks, the mean cyst diameter was 43+/-17 mm and 36% of all these cysts were already complicated (fluid-debris level, septa or finding of a retracting clot). Among the 16 non-complicated cysts (echolucent and thin-walled) 44% became twisted during the perinatal period irrespective of the size or the time of discovery. At birth, all these complicated cysts underwent surgical treatment and needed oophorectomy or adnexectomy. Surgery was therefore performed in a total of 56% of neonates. The pathologic reports confirm in all cases the benign follicular or follicular lutein nature of the cysts.

Conclusion: Due to this high rate of mechanical complications, cyst decompression may be considered at the time of diagnosis in case of an anechoic fetal ovarian cyst. The safety and efficacy of this approach, on the cases reported in the literature seem encouraging. Although, a prospective randomized evaluation is needed.