Neonates who have
ovarian torsion caused by an
ovarian cyst often lose their ovary because the torsion and
infarction occurred antenatally. Because ultrasound scan has been so effective in diagnosing
ovarian cysts in utero, we have a better understanding of their natural history and can select appropriate cases for
cyst decompression in utero to prevent torsion. The authors reviewed experience with seven fetuses who had
fetal ovarian cyst.
METHODS: During a 26-month period, seven patients were referred for the evaluation of
fetal ovarian cyst. The mean gestational age at presentation was 31.9 +/- 3.6 weeks (+/-SD; range, 27 to 37 weeks). There was no history of maternal risk factors such as
diabetes mellitus or fetal risk factors such as
hyperthyroidism or placentomegally. All seven cases involved isolated unilateral
cysts without associated anomalies or
chromosomal abnormalities. Mean initial
cyst diameter was 3.4 +/- 1.7 cm (+/-SD; range, 1 to 6.1). Indications used for
ovarian cyst decompression included anechoic
cysts with a diameter > or =4 cm, a
cyst "wandering" about the abdomen on serial sonograms, or demonstrating rapid enlargement (>1 cm/wk).
RESULTS: All but one
cyst progressed in size during observation. One
fetal ovarian cyst (diameter, 2 cm) subsequently regressed spontaneously and another (diameter, 2.1 cm) stabilized during prenatal ultrasound surveillance. One "
cyst" observed with a diameter of 3.5 cm proved to be a persistent cloaca. Four fetal
ovarian cysts met criteria for
decompression. Because of fetal position,
decompression could not be performed in one. One
cyst (seen before defining criteria for
decompression) with a diameter of 5 cm was observed only and underwent torsion. Two
cysts (diameters, 6.1 cm and 4 cm) were decompressed in utero under
local anesthesia with ultrasound guidance, of 95 mL and 35 mL, respectively. High cyst fluid
progesterone (12,041 and 1,990 ng/dL, respectively) and
testosterone (1,298 and 2,900 ng/dL, respectively) confirmed the etiology of the
cyst as ovarian. Neither
cyst recurred, and postnatal ultrasound scan confirmed resolution. There was no maternal or fetal morbidity or mortality and only the patient observed before development of criteria for
decompression lost her ovary because of torsion.
CONCLUSIONS: