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CC BY 4.0 · AJP Rep 2025; 15(02): e58-e61
DOI: 10.1055/a-2562-1898
Case Report

Prenatal Aspiration of Fetal Ovarian Cysts: When to Intervene? A Case Report and Review of the Literature

Giulia Bonanni 
1   Division of Fetal Medicine and Surgery, Fetal Care and Surgery Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
2   Department of Women, Children, and Public Health Sciences, IRCCS Agostino Gemelli University Polyclinic Foundation, Catholic University of the Sacred Heart, Rome, Italy
,
Scott A. Shainker 
3   Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
4   Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
,
Eyal Krispin
1   Division of Fetal Medicine and Surgery, Fetal Care and Surgery Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
,
Ryne A. Didier
1   Division of Fetal Medicine and Surgery, Fetal Care and Surgery Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
5   Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
,
Terry L. Buchmiller
6   Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
,
Alireza A. Shamshirsaz
1   Division of Fetal Medicine and Surgery, Fetal Care and Surgery Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Funding None.
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Abstract

Fetal adnexal cysts present unique challenges during pregnancy, requiring careful management strategies to mitigate risks throughout gestation and delivery. We present the case of a 35-year-old G4P2 patient, referred to our center for a large adnexal cyst confirmed by ultrasound (US) and fetal MRI, with a calculated volume of 210 mL. Given the cyst's size and the family's strong preference for vaginal delivery (VD), US-guided aspiration was performed at 356/7 weeks, followed by an uncomplicated spontaneous VD at 372/7 weeks. Two weeks postpartum, the ovarian cyst re-accumulated, requiring laparoscopic-assisted cystectomy in a torsed but viable left ovary. This case demonstrates the importance of individualized prenatal care, where clinical decisions balance parental preferences with medical risks. Maximizing the opportunity for vaginal birth was a top priority for the family, and the successful reduction of the cyst's size through percutaneous aspiration minimized the risk of abdominal dystocia and allowed for a safe VD. We review relevant literature, emphasizing the need for further research to refine fetal intervention criteria and improve outcomes for such cases.

Keywords

fetal adnexal cyst - ultrasound-guided aspiration - fetal intervention - individualized prenatal care - prenatal diagnosis

Authors' Contributions

All listed authors made substantial contributions to this manuscript. Specifically, G.B. and A.A.S. contributed to the conception and design of the manuscript. G.B. conducted the data acquisition. R.A.D. and T.L.B. assisted with the interpretation of data. All authors assisted with the drafting of the manuscript and reviewed and approved the final submitted version.


Patient Consent Statement

Verbal informed consent was obtained from the patient for the publication of this case report, including the use of de-identified data and imaging.




Publication History

Received: 22 January 2025

Accepted: 28 February 2025

Accepted Manuscript online:
19 March 2025

Article published online:
10 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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