Antenatally detected abdominal cyst: Does cyst size and nature determine postnatal symptoms and outcome?
Introduction
Advances in ultrasound technique have enabled more detailed assessment of fetal anomalies during antenatal screening [1,2]. This has facilitated earlier and more accurate detection of fetal anomalies including intra-abdominal cysts [3,4]. Cystic lesions within the fetal abdomen mainly arise from the developing gastrointestinal and genitourinary tract [5]. They represent a wide range of pathologies the commonest being ovarian, duplication and hepatobiliary cysts [6]. The evolution of such anomalies is highly variable. A proportion of intra-abdominal cysts regress during pregnancy or after birth, resolving without any clinical significance [7]. Nevertheless, some cysts can persist after birth, cause symptoms or complications, thus necessitating surgical intervention [8]. Relatively little data exists regarding the outcome and management of fetal intra-abdominal cysts. Thus, predicating the likeliest outcome remains challenging.
Features on antenatal ultrasound scans (USS), including the origin, size and morphology of a cyst, may be predictive of outcome [6,9,10]. Small, intra-parenchymal, unilocular cysts appear most likely to spontaneously resolve, whereas the likelihood of regression is seemingly reduced in larger, complex cysts [9,10]. Furthermore, cysts reaching larger diameters are at higher risk of complications (such as ovarian torsion, haemorrhage or bowel obstruction), thus increasing the risk of surgical intervention.
Knowledge of an intra-abdominal cyst's likely evolution can inform plans for antenatal follow-up and postnatal management, optimising the site of delivery and ensuring prompt perinatal review. Furthermore, it is important that prospective parents are counselled with regard to the expected outcome and the possibility of surgical intervention after birth [11]. Further research detailing the predictive value of antenatal USS may provide valuable data to inform prognostic counselling. This study aims to report the antenatal and postnatal course of fetal intra-abdominal cysts identified on antenatal USS and in particular, establish the value of cyst dimensions for predicting outcome.
Section snippets
Methods
A retrospective review of all fetuses with an intra-abdominal cyst outside the urinary tract seen at the joint Fetal Medicine and Paediatric Surgery Clinic at our Centre for Reproductive Health, between October 2013 and November 2019, was conducted. This is a tertiary referral unit receiving cases from the local population and specialist tertiary regional referrals to the fetal medicine department. All cases where an intra-abdominal cyst was the most likely diagnosis or could not be excluded
Results
During a 6-year period, 46 cystic lesions were identified on antenatal USS (Fig. 1). The final antenatal diagnosis in 8 cases was not an intra-abdominal cyst. One medical termination of pregnancy (MTOP) was recorded (an intra-abdominal cyst of unknown origin). The remaining cohort comprised 37 intra-abdominal cysts identified on the antenatal USS of 10 male (27.8%) and 26 female fetuses (72.2%). A single cyst was observed in all but one fetus where 2 intra-abdominal cysts of unknown origin were
Discussion
The evolution of intra-abdominal cysts is highly variable; predicting which will regress spontaneously and which will cause symptoms or complications necessitating surgery is challenging [6]. Uncertainty regarding the outcome of a cyst can complicate prognostic counselling offered to prospective parents and the planning of antenatal follow-up and postnatal management.
This study aimed to describe the antenatal and postnatal course of intra-abdominal cysts, diagnostic certainty antenatally and
Conclusion
In conclusion, the diagnostic accuracy of antenatal USS in this study seemed to be high. Characteristic growth profiles appear to separate ovarian from duplication cysts, with duplication cysts presenting earlier. The findings of this study also suggest that overall, cyst diameter on antenatal USS is predictive of persistence postnatally, but not surgery. The reliability of statistical results in this study was limited by the small sample size of certain subgroups. Thus, further research will
CRediT authorship contribution statement
Sarah Lewis:Methodology, Formal analysis, Investigation, Writing - original draft, Writing - review & editing.Jane Walker:Conceptualization, Investigation, Writing - review & editing.Merrill McHoney:Conceptualization, Methodology, Formal analysis, Investigation, Writing - review & editing.
Declaration of competing interest
None.
Acknowledgments
Thank you also to the staff at the Fetal Medicine Clinic for kindly assisting with the identification of cases and to Dr. Margaret McDougal for providing guidance on statistical analysis.
Funding
This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.
References (19)
- et al.
Fetal intra-abdominal tumors: assessment of spectrum, accuracy of prenatal diagnosis, perinatal outcome and therapy at a tertiary referral center
Eur. J. Obstet. Gynecol. Reprod. Biol.
(2013) - et al.
Prenatal diagnosis and the pediatric surgeon: the impact of prenatal consultation on perinatal management
J. Pediatr. Surg.
(1996) - et al.
The management of fetal ovarian cysts
J. Pediatr. Surg.
(2002) - et al.
Assessment of fetal anatomy at the 11–14-week ultrasound examination
Ultrasound Obstet. Gynecol.
(2004) - et al.
Prenatal diagnosis of intra-abdominal cystic lesions by fetal ultrasonography: diagnostic agreement between prenatal and postnatal diagnosis
Prenat. Diagn.
(2015) - et al.
Fetal intra-abdominal cysts: accuracy and predictive value of prenatal ultrasound
J. Matern-Fetal Neonatal Med.
(2016) Ultrasound and differential diagnosis of fetal abdominal cysts
Exp. Ther. Med.
(2017)- et al.
Foetal cystic abdominal masses
Australas. Radiol.
(2003) - et al.
Putative criteria for predicting spontaneous regression of prenatally diagnosed thoracoabdominal cystic lesions
Eur. J. Pediatr. Surg.
(2014)
Cited by (7)
Differentiating congenital ovarian cysts from other abdominal cystic lesions in female infants: A study by the Canadian Consortium for Research in Pediatric Surgery (CanCORPS)
2022, Journal of Pediatric SurgeryCitation Excerpt :This discrepancy may be explained by the exclusion of urinary tract anomalies which usually do not necessitate surgical intervention in the postnatal period. The predictive value and diagnostic accuracy of prenatal ultrasound imaging in identifying the origin of fetal abdominal cysts has been previously reported [1,2,4,7,15,22]. In a of series of 71 patients, Ozyunca et al. reported a positive predictive value of 75% in the identification of a clear organ of origin for an abdominal cyst, with an overall sensitivity of 88.1%, specificity of 73.1%, and false positive rate of 5% [4].
Hydrometrocolpos: a Contemporary Review of the Last 5 Years
2023, Current Urology ReportsManaging Fetal Ovarian Cysts: Clinical Experience with a Rare Disorder
2023, Medicina (Lithuania)Congenital ovarian cyst: diagnosis and treatment at neonatal period
2023, Paediatric Surgery (Ukraine)Intestinal duplication and prenatal differential diagnosis of intra-abdominal cysts
2023, Ginecologia y Obstetricia de Mexico