Outcome of fetal ovarian cysts diagnosed on prenatal ultrasound examination: systematic review and meta-analysis

Abstract

OBJECTIVES: To explore the outcome of fetuses with a prenatal diagnosis of fetal ovarian cysts. METHODS: Medline and Embase databases were searched. The following outcomes were explored: resolution of the cyst, change of ultrasound pattern, occurrence of ovarian torsion and intra-cystic haemorrhage, need for surgery, need for oophorectomy, detection rate of prenatal ultrasound in correctly identifying ovarian cysts, type of ovarian cyst at histopathological analysis and intra-uterine treatment. Meta-analyses using individual data random-effect logistic regression and meta-analyses of proportion were used to analyse the data. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale. RESULTS: Thirty-four studies (954 fetuses) were included. 54.6% (95% CI 47.0-62.0) of the cysts regressed either during pregnancy or after birth. The likelihood of resolution was significantly lower in complex vs simple cysts (OR: 0.15, 95% CI 0.10-0.23) and in those ≥ 40 compared to < 40 mm (OR: 0.03, 95% CI 0.01-0.06). Change in ultrasound pattern was associated with an increased risk of ovarian loss (PP: 57.7%, 95% CI 42.9-71.8). The risk of ovarian torsion was significantly higher in cysts ≥ compared to those < 40 mm (OR: 30.8, 95% CI 8.6-110). The risk of having surgery was higher in patients with cysts ≥ compared to <40 mm (OR: 64.4, 95% CI 23.6-175) and in complex cysts compared to simple cysts, irrespective of the cyst size. In cases undergoing prenatal aspiration of the cyst, the rate of recurrence was 37.9% (95% CI 14.8-64.3), while torsion and haemorrhage were diagnosed after birth in 10.8% (95% CI 4.4-19.7) and 9.7% (95% CI 3.7-18.3) of the cases treated. Finally, 17.7% (95% CI 9.3-,28) of fetuses undergoing fetal therapy had surgery after birth. CONCLUSION: Cysts size and appearance are the major determinants of perinatal outcome in these anomalies