Bonanni Giulia, Shainker Scott A, Krispin Eyal, Didier Ryne A, Buchmiller Terry L, Shamshirsaz Alireza A
Division of Fetal Medicine and Surgery, Fetal Care and Surgery Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Women, Children, and Public Health Sciences, IRCCS Agostino Gemelli University Polyclinic Foundation, Catholic University of the Sacred Heart, Rome, Italy.
AJP Rep. 2025 Apr 10;15(2):e58-e61. doi: 10.1055/a-2562-1898. eCollection 2025 Apr.
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 weeks, followed by an uncomplicated spontaneous VD at 37 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.
胎儿附件囊肿在孕期带来独特挑战，需要谨慎的管理策略以在整个妊娠期和分娩过程中降低风险。我们报告一例35岁、孕4产2的患者，因超声（US）和胎儿磁共振成像（MRI）确诊为大的附件囊肿而转诊至我院，囊肿计算体积为210 mL。鉴于囊肿大小及患者家庭强烈希望经阴道分娩（VD），在35周时进行了超声引导下穿刺抽吸，随后在37周时顺利经阴道自然分娩。产后两周，卵巢囊肿复发，对扭转但仍存活的左卵巢进行了腹腔镜辅助囊肿切除术。该病例表明个体化产前护理的重要性，临床决策需在父母意愿与医疗风险之间取得平衡。对患者家庭来说，最大化经阴道分娩机会是首要任务，通过经皮穿刺抽吸成功缩小囊肿大小，将腹部难产风险降至最低并实现了安全的经阴道分娩。我们回顾相关文献，强调需要进一步研究以完善胎儿干预标准并改善此类病例的结局。
