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.     

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.     

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.     

Changing sonographic features of fetal ovarian cysts during pregnancy and the neonatal period

We present a case in which serial sonographic examinations revealed changing pattern of cystic ovarian masses from hypoechogenic to echogenic appearance. These changes were attributed to suspected torsion of ovarian cyst. Nevertheless, a healthy baby girl was born without clinical and sonographic evidence of ovarian torsion. Received: October 1998 / Accepted: 12 January 1999     

Fetal ovarian cysts. Our clinical experience over 16 cases and review of the literature

Objective.?Fetal ovarian cysts are intra-abdominal structures frequently diagnosed prenatally, tending to present as isolated unilateral lesions in normal fetuses in the third trimester. These cysts may present with complications and their diameter and echogenicity are the main criteria for establishing their prognosis. Spontaneous regression of fetal ovarian cysts is very usual. In the present study, we present our clinical experience on fetal ovarian cyst surveillance and treatment, as well as a review of the literature in the same field.

Material and method.?In this study, we reviewed pre- and postnatal medical records and ultrasonography of 16 fetuses that were diagnosed with ovarian cysts, in Obstetrics Department of University Hospital of Alexandroupolis, between January 2000 and April 2010. We have also reviewed the available literature about fetal ovarian cysts.

Results.?In a total of 16 cases, postnatal surgery was performed in one infant due to ovarian cyst torsion. In the remaining 15 cases, cysts regressed completely in two fetuses during pregnancy and all the rest of the cysts, including four complex ones, resolved spontaneously after birth.

Conclusions.?When fetal ovarian cysts are detected, they should be followed up by serial ultrasonographic examinations. The majority of them will regress spontaneously in a period of 12 months after birth, independent of their sonographic findings. Only symptomatic cysts or cysts with a diameter >5 cm, which do not regress or enlarge, should be treated.     

Recurrent fetal complex ovarian cysts with rupture followed by simple cyst in the neonatal period with no adverse sequelae

Fetal ovarian cysts are the most frequent type of abdominal tumors in female fetuses with prenatal detection rate of more than 30%. The etiology of fetal ovarian cysts is unclear, but hormonal stimulation as well as presence of maternal diabetes, hypothyroidism, Rh iso-immune hemolytic disease and toxemia has been generally considered responsible for the disease. Complications of fetal ovarian cysts include compression of other viscera, cyst rupture, hemorrhage and, most frequently, ovarian torsion with consequent loss of the ovary. Management is controversial with several options described in the literature, including watchful expectancy, antenatal aspiration of simple cysts to prevent torsion and ovarian loss and finally, resection of all complex cysts in the neonatal period. To date, no case report has described recurrent complex cysts with rupture in the fetal period and recurrence of simple cyst in neonatal period. By presenting this case, we wanted to show that surgical intervention in case of prenatally diagnosed fetal ovarian cyst should be considered postnatally and only in symptomatic or complicated cases.     

Benign ovarian cysts in premenopausal women

Benign ovarian cysts are a common gynaecological presentation seen in both the elective and emergency setting. Up to 10% of women will have surgery for an ovarian cyst in their lifetime. When an adnexal mass is diagnosed the differential diagnosis is wide and up to 10% may be non-ovarian in origin. The goal of management is to determine the underlying pathology and to risk stratify patients to guide further management. Transvaginal ultrasound scanning remains the imaging modality of choice and the use of simple rules as well as benign and malignant features should form the basis for diagnosis, with serum markers used as an adjunct. Cross-sectional imaging with other modalities including magnetic resonance imaging are useful in the management of indeterminate masses. The vast majority of ovarian cysts are benign in nature and most functional and simple cysts are likely to resolve spontaneously without intervention. This review will demonstrate four clinical scenarios with different underlying pathologies and their management.     

Clinical experience of five fetal ovarian cysts: diagnosis and follow-up

Backround Ovarian cysts are the most frequent type of abdominal tumor, in female newborns. The most of the cases resolve spontaneously with no clinical significance. However, ovarian cysts often present complications such as torsion. Case The authors reviewed the pre- and postnatal records and ultrasonograms of five fetuses, who were diagnosed with ovarian cysts. No complication was observed prenatally. However, one infant 2 months after birth required surgical intervention because of cyst torsion. The cysts of the other four infants showed complete resolution in a time interval of 3–9 months. Conclusion An ovarian cyst is not a life-threatening condition, so they should be just closely monitored pre- and postnatally until spontaneous resolution. When torsion of the cyst is suspected, surgical intervention is necessary.     

Four neonates with giant ovarian cysts: difficulties in diagnosis and decision making process

Objective: Ovarian cysts compose most of the intraabdominal cysts in fetal period. Most of them regress spontaneously at intrauterine or postnatal period. The cysts that are complicated and do not regress are excised generally. Methods: Here we report a case series that consists of four newborns having giant (≥10?cm) ovarian cysts. All of the patients were term infants and followed for ovarian cysts in intrauterine period. Results: Patients were operated on 5, 11, 28, 47th days, respectively. Three patients had unilateral cysts (two right, one left) and one had bilateral cysts. One of the four patients had bilateral ovarian cysts, 100?×?95?mm in diameter on the left and 50?×?55?mm on the right, which was torsioned. Conclusion: The risk of complications is higher in bilateral cysts even they are smaller, and early surgical intervention should be done to these patients. During the operation of one of the patients, we detected the cyst at the opposite side that was shown by ultrasonography. Since the size of the mass is large, detecting the correct origin of the cyst is important for the selection of appropriate surgical approach.     

Fetal intra-abdominal cysts: accuracy and predictive value of prenatal ultrasound

Objective: The finding of a fetal intra-abdominal cyst is relatively common and it can be due to a wide variety of clinical conditions. The aims of this study were to determine the accuracy of the prenatal ultrasound (US) in identifying the etiology of fetal intra-abdominal cysts and to describe the neonatal outcomes.

Methods: All cases of fetal intra-abdominal cystic lesion referred to our center between 2004 and 2012 were reviewed. Cysts of urinary system origin were excluded. Prenatal and postnatal data were collected. Our cohort was divided into subgroups according to the prenatal suspected origin of the lesion (ovarian, mesenteric, gastro-intestinal and other locations). For each subgroup, sensitivity, specificity, positive predictive value, false-positive rate and accuracy of fetal US were calculated.

Results: In total 47 fetuses (10/37?M/F) were identified. The mean gestational age at the time of diagnosis was 33?±?4.9 weeks. Our cohort comprised of 25 ovarian cysts (10 simplex and 15 complex), 3 GI duplication, 6 mesenteric lesions, 4 meconium pseudocyst and 9 lesions of other origin. Surgery was performed in 38 cases (81%) at birth. The prenatally established diagnosis was exactly concordant with post-natal findings in 34 cases (72.3%). Sensitivity, specificity, positive predictive value and false-positive rate of US were 88.1%, 95.5%, 71% and 5.4%, respectively. Long-term outcome was good in almost 90% of the cases.

Conclusions: The etiology of fetal intra-abdominal cysts can be prenatally diagnosed in about 70% cases. Despite the high risk of surgery at birth, the long-term outcome was good in most of the cases.     

The fetal anomaly scan

Congenital abnormalities are a common cause of perinatal mortality and may have implications for life expectancy and quality of life in the future. Ultrasound screening in pregnancy can detect major congenital abnormalities in 2–3% of fetuses. Screening provides the opportunity for a diagnosis to be made prior to birth, for further investigations and monitoring to be offered, and for prognosis to be discussed. Conditions may be identified that would benefit from prenatal treatment, delivery at a different centre, or highlight that the baby may die shortly after birth. In countries where the law permits termination of pregnancy it can give the opportunity to choose not to continue the pregnancy. This article describes the Fetal Anomaly Screening Programme (FASP) in the UK and describes a systematic approach for scanning for fetal anomalies in the first and second trimester.     

Laparoscopic excision of large ovarian cysts

OBJECTIVE: The aim of this study was to check the ability of operative laparoscopy to help in the management of large ovarian cysts that may reach above the level of the umbilicus. MATERIAL AND METHODS: Fifteen cases of large ovarian cysts reaching above the level of the umbilicus were chosen. Clinical and ultrasonic diagnosis denied any signs of malignancy. Pneumoperitoneum and a 5 mm trocar were inserted safely in the left midclavicular line below the ninth costal margin. This trocar allowed us to inspect the peritoneal cavity thoroughly. Another 5 mm trocar was inserted suprapubically in the contralateral side of the cyst and better inspection of the cyst and peritoneal cavity was then done. In the case of an apparently benign cyst, aspiration of the cyst fluid was done after puncturing its wall, then the cyst was removed as usual. RESULTS: In all of these cases, there was no laparoconversion and no other complications were recorded. Nine cases were mucinous and six were serous cystadenomas. The mean operation time was 53.66 +/- 14.7 min. CONCLUSION: Laparoscopic excision of large ovarian cysts is possible, and safe in suitable conditions, with immediate laparoconversion at hand at any time.     

Ultrasonic detection of bilateral ovarian cysts in the fetus

Bilateral ovarian cystic tumors in the fetus were diagnosed by ultrasound at the 39th wk of pregnancy. The diagnosis was confirmed at laparotomy 8 days after cesarean section. The diagnostic and therapeutic aspects of the fetal and neonatal ovarian cysts are discussed.     

Diagnostic accuracy of non-invasive fetal RhD genotyping using cell-free fetal DNA: a meta analysis

Abstract

Objective: To determine the diagnostic accuracy, validity, current limitations of, and possible solutions to, fetal RhD genotyping from maternal blood based on existing studies written in English.

Methods: A literature search was conducted that described fetal RhD determination from maternal blood. The number of samples tested, fetal RhD genotype, the source of cell-free fetal DNA, gestational age and fetal Rh type were examined in each study to calculate the accuracy, sensitivity and specificity of fetal RhD genotyping.

Results: Forty-one publications, which included 11?129 samples with non-invasive Rh genotyping of cell-free fetal DNA from maternal blood, were selected. After the exclusion of 352 inconclusive samples, the overall diagnostic accuracy was 98.5% (10?611/10?777), and sensitivity and specificity were 99% and 98%, respectively. First trimester diagnosis showed an accuracy of 99%, higher than second and third trimester diagnosis. Thirty studies reported a 100% diagnostic accuracy of fetal RhD genotyping.

Conclusion: Non-invasive fetal RhD genotyping from maternal blood has high accuracy, sensitivity and specificity. Methods reducing false results have been explored and applied in research. These achievements indicate that this technique will be widely used in routine clinical care.     

Giant ovarian cysts: Is a pre- and intraoperative drainage an advisable procedure?

There has been a considerable debate over the merits of a pre- or intraoperative drainage of giant ovarian cysts, which represented a very frequent approach before definitive surgery in the past. Including our presented case of a 57-year-old woman with a 49 kg mucinous cystadenoma, 19 patients with giant ovarian cysts weighing more than 40 kg were reported in the literature since 1970. An incidence of 37% of malignant and low malignant potential tumors was found. Based on a critical evaluation of the medical courses and the discussed miscellaneous advantages and complications, we conclude that a pre- and intraoperative drainage should be avoided.     

Differential diagnosis of sonographically detected tumours in the fetal cervical region

Differential diagnosis of sonographically detected fetal neck tumours is difficult. The sonographic criteria for encephalomyelocele, lymphangioma/hygroma, teratoma, sarcoma, haemangioma, neuroblastoma and goitre are given on the basis of the authors' own observations and information from the literature. Elevation of alpha-fetoprotein in the amniotic fluid is a frequent but non-specific finding. Chromosome analysis after amniocentesis can be a useful supplementary procedure for assessing the prognosis and deciding upon the delivery procedure. Sonographic detection of a tumour in the fetal neck region enables preparations to be made for dystocia and postnatal dyspnoea of the newborn. The obstetrician must cooperate closely with paediatricians, neurologists, surgeons and ENT specialists.