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

## TL;DR

A pregnant woman with a large fetal ovarian cyst underwent prenatal aspiration to enable a vaginal delivery, followed by postpartum surgery to address cyst recurrence.

## Contribution

This case report highlights the successful use of prenatal aspiration to facilitate vaginal delivery in a patient with a large fetal ovarian cyst.

## Key findings

- US-guided aspiration of a 210 mL fetal ovarian cyst at 35 weeks allowed for a successful vaginal delivery.
- Postpartum cyst recurrence required laparoscopic-assisted cystectomy in a torsed but viable ovary.
- The case underscores the importance of individualized prenatal care balancing parental preferences and medical risks.

## 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 35
6/7
weeks, followed by an uncomplicated spontaneous VD at 37
2/7
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.