Outcome of fetal ovarian cysts following in-utero aspiration vs expectant management: multicenter cohort study

Abstract

Objective: The primary aim was to evaluate pre- and postnatal morphological changes in large simple fetal ovarian cysts following in-utero aspiration compared with expectant management. Secondary aims were to assess postnatal outcome in terms of surgical intervention and to evaluate complications associated with in-utero aspiration. Methods: This was a retrospective observational cohort study, conducted between January 2006 and May 2023 in four centers associated with a multidisciplinary prenatal diagnosis center in the Paris area, France. We included all cases with prenatally diagnosed fetal ovarian cysts measuring ≥ 30 mm at least once during prenatal ultrasound follow-up and classified as simple at referral. The primary outcome was the occurrence of pre- and/or postnatal changes in cyst morphology during ultrasound follow-up suggestive of ovarian hemorrhage or torsion. Postnatal surgery included ovarian oophorectomy or cystectomy performed via laparoscopy or laparotomy. The chi-square test or Fisher's exact test was used, as appropriate, to compare categorical variables between pregnancies that underwent in-utero aspiration vs expectant management, while Wilcoxon's rank-sum test was used to compare continuous variables. Results: Sixty-five fetal ovarian cysts measuring ≥ 30 mm were included: 18 (27.7%) were managed by in-utero ultrasound-guided transabdominal aspiration and 47 (72.3%) were managed expectantly. Gestational age at diagnosis did not differ significantly between groups (median, 33.0 (interquartile range (IQR), 32.0–33.3) weeks vs 32.6 (IQR, 31.4–33.4) weeks). The maximum prenatal cyst diameter was greater in cases that underwent in-utero aspiration compared to those managed expectantly (median, 45 (IQR, 40–55) mm vs 39 (IQR, 32–45) mm; P < 0.01). The median gestational age at in-utero aspiration was 34.2 (IQR, 33.5–36.1) weeks. Pre- and/or postnatal morphological changes suggestive of ovarian hemorrhage or torsion were reported in 1/18 (5.6%) cysts that were aspirated prenatally and 21/47 (44.7%) cysts managed expectantly (P = 0.003). Postnatal surgery was performed in 1/18 (5.6%) and 5/47 (10.6%) cases, respectively (P = 0.66). One case of preterm prelabor rupture of membranes occurred following in-utero aspiration at 36.4 weeks. Conclusions: In-utero aspiration may help to prevent changes in cyst morphology and related complications in large simple fetal ovarian cysts. Larger prospective studies are needed to confirm this potential benefit; however, definitive evidence would require systematic postnatal surgical exploration in infants with an ovarian cyst, which is not warranted. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.