Fetal ovarian cysts management and ovarian prognosis: a report of 82 cases.
OBJECTIVE
Fetal ovarian cysts are frequently complicated by intracystic hemorrhage without associated clinical signs, which is often secondary to ovarian torsion leading to loss of the ovary. The aim of this study was to evaluate ovarian outcome and the place of prenatal management and surgery in the first few days of life in order to save the ovary.


METHODS
Between January 1987 and June 2006, 82 fetal ovarian cysts in 79 patients were managed and clinically and ultrasonographically followed up for several months (median, 11 months; range, 6 months to 10 years) in all of the cases where the ovary was not removed. The ultrasonographic results regarding the ovarian parenchyma were broken down into 3 categories: follicular ovary, homogeneous ovary, and undetected ovary.


RESULTS
Twenty-seven cysts remained simple throughout their evolution, and 55 were complicated by intracystic hemorrhage usually several weeks before birth. Overall, after disappearance of the cyst, a follicular ovary was detected in only 39% of the cases (32/82) and more often when the cyst was simple than when it presented an intracystic hemorrhage (85% vs 16.4%, chi(2), P < .0001).


CONCLUSIONS
A review of our series confirms the poor ovarian outcome linked to ultrasonographic signs of intracystic hemorrhage. Preventive action by puncture of "simple" cysts is still being studied. The presence of a bilateral cyst can, if pulmonary maturity has been reached, be an argument for inducement of premature birth with a view to performing conservative surgery. After birth, surgery in the first few days of life is only justified if the signs of intracystic hemorrhage appeared in the period very close to birth.
Galinier
Philippe
P
Department of Pediatric Surgery, Children's Hospital, TSA 70034, 31059 Toulouse Cedex 9, France.
Carfagna
Luana
L
Juricic
Michel
M
Lemasson
Frederique
F
Moscovici
Jacques
J
Guitard
Jacques
J
Baunin
Christiane
C
Menendez
Marcella
M
Cartault
Audrey
A
Pienkowski
Catherine
C
Kessler
Sylvie
S
Sarramon
Marie-France
MF
Vaysse
Philippe
P
D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D010048:Ovarian Cysts / Q000150:complications / Q000000981:diagnostic imaging / Q000196:embryology* / Q000473:pathology / Q000601:surgery; D010052:Ovariectomy / Q000379:methods; D011677:Punctures; D012189:Retrospective Studies; D014463:Ultrasonography; D019564:Unnecessary Procedures