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