Fetal goiter and bilateral ovarian cysts

A unique case of fetal goiter accompanied by bilateral ovarian cysts in a mother treated with methimazole for Graves'disease is reported. The abnormal findings were detected by ultrasound at 31 weeks of gestation. Umbilical fetal blood sampling revealed elevated serum TSH, normal concentrations of free T 4 , normal FSH and LH and high concentrations of E 2 . A series of weekly amniocenteses and intra-amniotic injections of levothyroxine was initiated, along with a reduction of the mother's methimazole dosage. The level of TSH in amniotic fluid was initially high, but was considerably reduced by each injection and followed by a gradual reduction of fetal goiter as well as the left ovarian cyst. The right cyst ruptured spontaneously. At 36 weeks + 4 days, the patient underwent elective caesarean section and gave birth to a female, weighing 2,880 g with 1- and 5-min Apgar scores of 10. The thyroid gland appeared normal in size, and cord blood TSH and free T 4 were both within normal limits. At ultrasound control 6 days later, the right ovarian cyst was not visible, while the left cyst was still present. Thus, our report supports previous findings that fetal goiter can be treated successfully with intra-amniotic injection of levothyroxine.More importantly, it shows that fetal hypothyroidism with elevated levels of TSH can be accompanied by ovarian cysts,suggesting interference between thyreotropic and gonadotropic hormones.     

Ultrasonic diagnosis of fetal ovarian cysts

A clinical case of fetal ovarian cyst diagnosed at the 22nd week of pregnancy and disappearing at the 34th week is reported. The echographic and clinical criteria underlying diagnosis and obstetrical conduct in cases of fetal abdominal tumescence of probable ovarian origin are discussed.     

Concurrent maternal and fetal ovarian cysts

Due to improvements in ultrasonography, the detection of fetal abdominal masses has increased. We describe a case of co-existing maternal and fetal ovarian cysts in a 37-year-old primiparous woman. The fetal ovarian cyst was first identified in the third trimester and reached a maximum diameter of 9?cm. The maternal cysts were present from 20 weeks onwards; with a maximum diameter of 8?cm. Histological examination showed the maternal lesions were benign dermoid cysts. The fetal lesion resolved spontaneously by 5 months. This case illustrates that fetal and maternal ovarian cysts may co-exist and could potentially have a similar hormonal etiology.     

Management of antenatally diagnosed fetal ovarian cysts

1. Fetal ovarian cysts are usually unilateral, diagnosed in the third trimester and are uncommon. 2. Average ovarian cyst size is 5 x 5 cm at diagnosis and size does not change throughout the pregnancy. 3. Most cysts are functional in origin and histologically benign, simple cysts. 4. Polyhydramnios is a common finding but associated anomalies are rare. 5. Although large cysts can compress other viscera and torsion or rupture can occur, in utero aspiration has limited value in prenatal management. 6. Vaginal delivery with confirmed fetal pulmonary maturity or at term is appropriate. 7. Soft tissue dystocia is rare. Cesarean delivery should be reserved for obstetrical indications only. 8. The best predictor of neonatal cyst torsion risk is length of the cyst pedicle rather than cyst size. 9. When surgery is indicated a cystectomy, with preservation of maximal ovarian tissue is to be preferred over oophorectomy. 10. Ultrasound-guided aspiration of neonatal ovarian cysts may be an alternative to surgical management.     

Outcome of sonographically suspected fetal ovarian cysts

Abstract

Objective: Fetal ovarian cysts (FOCs) are the most common intra-abdominal cystic structures formed during antenatal period. The aim of this study was to evaluate prenatal characteristics and postnatal outcome of sonographically suspected FOCs.

Methods: We reviewed prenatal sonographic data and postnatal medical records of 29 fetuses that were suspected to have ovarian cysts in our hospital, between January 2001 and September 2012. Perinatal outcomes were obtained for all cases.

Results: In a total of 29 cases, we confirmed initial antenatal diagnosis of ovarian cyst in 20 cases (68.9%) at postnatal period. Diagnosis of remaining nine cases revealed urogenital sinus anomaly in four cases, multicystic dysplastic kidney in two cases, mesenteric cyst in one case, intestinal duplication cyst in one case and lymphangioma in one case postnatally. In seven of the 20 ovarian cysts (35%), resolution of the cyst occurred prenatally. Intrauterine death of a fetus occurred at second trimester. In the postnatal period, most often cases (11/20) were spontaneously resolved and surgery was performed on two babies due to ovarian torsion (2/20).

Conclusion: Differential diagnosis of FOCs should always include genitourinary tract disorders, gastrointestinal tract disorders and other intra-abdominal cystic structures.     

Fetal ovarian cysts: incidence, diagnosis and management

Greater numbers of fetal ovarian cysts are being diagnosed due to improved antenatal imaging. These numbers correspond to data from autopsy studies showing approximately 30% of neonates to have ovarian cysts. Fetal ovarian cysts pose a risk of acute and long-term complications. These risks must be weighed against the probability of cyst regression. The de- The decision to cision to intervene must be based on cyst based on cyst size, ultracharacteristic sound characteristics and clinical symptoms. Treatment options include conservative management, antenatal or neonatal cyst aspiration, laparoscopic cystectomy and laparotomy. Diagnosis is important, given the possible complications and the current management options. Criteria for management have been established at several centers; however, a controversy over conservative versus surgical therapy remains.     

Invasive fetal therapies: approach and results in treating fetal ovarian cysts

Objective.?To show the validity of prenatal invasive surgical intervention when a fetal ovarian cyst is diagnosed, compared to a wait and see attitude, in order to avoid possible prenatal and postnatal complications.

Patients.?Fourteen cases of intra-abdominal cysts monitored in our center between April 2005 and November 2010. All cases were first diagnosed in the third trimester, and were monitored for the remainder of the pregnancy and after delivery (2 months–3 years postnatally).

Surgical intervention.?Upon maternal and fetal cutaneous anesthesia performed trans-amniotically, the cystic fluid (mean contents 43.85 cc, DS 46.27) was extracted for cytological, biochemical, and hormonal examination.

Results.?Thirteen cases of intra-abdominal cysts (92.8%) were fetal ovarian cysts. Ninety-two percent of pregnancies bearing such a condition were successfully concluded (n?=?12). Sixty-nine percent concluded in vaginal delivery (n?=?9). None experienced maternal and/or fetal complications. Every drained cyst had an estradiol concentration higher than 10,000 pg/ml.

Conclusions.?The aspiration of ovarian cysts exceeding a 40 mm diameter, performed as early as possible, allows a good longitudinal treatment of this fetal affection, thus avoiding torsion, tissue necrosis, and invasive postnatal surgery, as well as giving hope of future gestational capability to the fetus/newborn.     

Prenatal diagnosis and management of fetal ovarian cysts

Congenital ovarian cysts are a pathological condition which can be diagnosed in utero by ultrasound. We report 14 consecutive diagnoses of fetal ovarian cysts, obtained in the second and third trimesters of pregnancy. Congenital ovarian cysts have almost invariably a good prognosis, and no change in the standard obstetrical management is required. However, the evolution of the disease in utero is extremely variable. The cyst may increase in size, decrease or even disappear, or undergo complications such as torsion and rupture, which may carry some risks to the fetus. When a fetal ovarian cyst is detected, serial ultrasound examinations should be performed. If one of the above complications is suspected, the option of prompt caesarean section should be considered.     

Fetal development and fetal heart function analyzed by M-mode echocardiography

Real time-directed M-mode echocardiograms were obtained for 215 echographically evaluated AFD fetuses between 24 and 41 weeks of gestation to assess the cardiac function of normally growing human fetuses. The results are as follows. 1. A significant linear correlation exists between gestational weeks and end-diastolic wall thickening of RV, IVS and LV, respectively (RVAWTd, IVSTd and LVPWTd). 2. There is no significant difference among three (RVAWTd, IVSTd and LVPWTd) at any time from 24 to 41 weeks. 3. Percent systolic wall thickening for RV, IVS and LV are 39 +/- 24, 68 +/- 37 and 41 +/- 16(%), respectively. 4. Motion of IVS towards left ventricular free wall during systole, no septal motion or paradoxical movement (systolic septal anterior motion) is seen in 62, 35 and 3% of cases, respectively. 5. Paradoxical movement of IVS is seen in the case in which the RV/LV wall exclusion ratio is extremely low.     

Fetal echocardiography

Fetal echocardiography is an essential technique in the evaluation and management of fetal disease. Recent reviews address the accuracy of the technique, the benefit of routine screening, the association with chromosomal defects, and outcomes in fetuses with the prenatal diagnosis of congenital heart disease. Advances in Doppler have resulted in the more accurate and rapid diagnosis of structural heart disease, and in the use of this technique in the physiological assessment of fetal disease states.     

Fetal echocardiography

Fetal echocardiography has become an essential tool for the thorough evaluation of the fetus at risk for congenital heart disease. This examination is now a part of standard medical practice and should no longer be considered investigational. Widespread use of fetal echocardiography is providing valuable insights into fetal cardiac embryology and physiology that have not been previously possible.     

Fetal echocardiography

A limited form of fetal heart examination is feasible by the ultrasonographer involved in routine scanning, allowing selection of fetuses with major forms of heart disease in the overall pregnant population. Detailed and accurate prediction of cardiac malformation is possible in a specialized center studying pregnancies at increased risk of heart disease in the offspring, and those pregnancies selected by obstetric scanning. Fetal hemodynamics can be studied by Doppler echocardiography allowing new insights into the fetal circulation. Fetal arrhythmias can be documented and successfully treated before birth.     

Assessment of the usefulness of ultrasound screening in fetal ovarian cysts

OBJECTIVES: The aim of the study was to assess the usefulness of ultrasound in management and prognosis in fetal ovarian cysts. MATERIAL AND METHODS: The study included 38 fetuses with cyst in abdominal cavity, who, between 1995 and 2006, underwent an ultrasound examination in our unit at the Polish Mother's Memorial Hospital in Lodz, The Department for Diagnosis and Prevention of Birth Defects. RESULTS: In all 38 fetuses with cyst in abdominal cavity we have diagnosed 27 (74%) cases of ovarian cyst. In 14 (74%) fetuses cysts regressed spontaneously, including all cysts < or = 40mm (n = 7). In 3 cases with cysts > 40mm needle aspiration has been successfully performed, without any further complications. Surgical neonatal treatment has been performed in 5 cases in prenatal cysts > 40mm without prenatal aspiration. In 3 cases cysts > 40mm regressed spontaneously. Ovarian cysts in 22 (87%) cases were an isolated malformation; in 5 (19%) cases other malformations were present CONCLUSIONS: 1. Fetal ovarian cysts < or = 40mm required only ultrasound assessment and, in majority of cases, revealed the tendency to spontaneous regression. 2. Cysts > 40mm in maximal diameter have signaled complications more often and required surgical procedure after birth. 3. In utero, aspiration of fetal ovarian cyst > 40mm may lead to cyst regression, making the surgery after birth unnecessary.     

Fetal ovarian cysts: prenatal ultrasonographic detection and postnatal evaluation and treatment

Ovarian cysts were diagnosed by antenatal ultrasonographic examination in 15 fetuses between 19 and 37 weeks' gestation. In six cases there was ultrasonographic evidence of torsion. Intracystic flocculation, which typically was deposited on the sloping part of the cyst, gave a characteristic liquid interface that was regarded as ultrasonographic evidence of torsion. All cases with evidence of torsion were managed surgically post partum, and in all patients this complication was confirmed. The remaining nine cases were followed up by repeated ultrasonograms, and in all patients disappearance of the cyst was documented within the first 6 months of life. The mean size of cysts with evidence of torsion was 5.41 +/- 0.25 cm, and the mean size of those without torsion was 4.33 +/- 0.3 cm (p less than 0.01). Histologic examination of the surgical specimen in the cases with evidence of torsion revealed follicular cysts in three cases and necrotic ovarian cysts with no specific epithelial findings in the remaining three. We recommend continuous ultrasonographic assessment of antenatally diagnosed cysts and believe that the choice of treatment depends on the appearance of the cyst and its evolution throughout pregnancy.     

Ultrasonographic diagnosis of fetal ovarian cysts: Five cases in five years

Objective. To evaluate the outcome of ultrasonographically diagnosed fetal ovarian cysts within a 5-year period.

Methods. This was a retrospective evaluation of the prenatal and postnatal medical records of the five cases of fetal ovarian cyst diagnosed at our institution from January 2002 to December 2006.

Results. The mean gestational age at diagnosis was 31.6 weeks. One of the patients had type I diabetes and another had chronic hypertension and preeclampsia. The mean cyst diameter at diagnosis was 38.3 mm (range 29–60 mm). When diagnosed, four of the cysts were simple and the other was septated. During pregnancy, the septated cyst and two of the simple cysts became hemorrhagic. Postnatally the septated cyst and two of the simple cysts underwent spontaneous remission; the other two cases, corresponding to hemorrhagic cysts, were surgically removed after birth.

Conclusions. The best clinical approach to a fetal ovarian cyst is controversial. In this small series, three of the five cysts regressed spontaneously, including a hemorrhagic one. Once a fetal ovarian cyst is diagnosed, ultrasonographic monitoring should be provided in order to identify complications and define the best therapeutic approach.