PM1061: Factors Associated with Ovarian Loss and Surgical Intervention for Perinatal Ovarian Cysts

Background: Perinatal ovarian cysts are a common finding in female fetuses and neonates. Clinically significant cysts may spontaneously resolve or lead to complications including torsion and ovarian loss. Cyst size and appearance are often used to characterize cysts and guide surgical decision making. However, the natural history of these lesions and the impact of perinatal interventions on ovarian outcomes remain unclear. We investigated the degree to which various clinical parameters were associated with operative intervention as well as ovarian loss.

Methods: We reviewed both maternal and infant records for all perinatal cysts diagnosed between a gestational age of 15 weeks and a postnatal age of 2 years suspected to be of ovarian origin across three hospital systems from November 2006 to January 2022. Clinical variables were extracted related to prenatal imaging, birth data, postnatal courses, and perioperative outcomes. Cysts were characterized based on size, morphology (simple vs. complex), laterality, and evolution. Cyst resolution was determined based on sonographic evidence of decreasing size and normal ovarian appearance. Outcome measures included rates of resolution, ovarian loss, and operative intervention. Comparative analyses were performed using Mann Whitney-U and Fisher’s Exact testing for continuous and categorical variables. Optimal cutoffs for the maximal cyst sizes associated with ovarian loss and operative intervention were obtained using ROC curves.

Results: We identified 62 female patients with perinatal ovarian cysts, of which 56 were diagnosed prenatally and 6 postnatally. Only one cyst was treated with prenatal aspiration. Without any operative intervention, cysts spontaneously resolved in 35 patients, but were associated with prenatal ovarian loss in 9 others. Of 18 patients undergoing surgical cystectomy, 9 operations revealed non-viable ovary, resulting in a combined overall rate of ovarian loss of 29% (Figure 1). Ovarian loss occurred more frequently with larger cysts, in those with complex morphology, and occurred more frequently with right-sided cysts (Table 1). Operative intervention occurred more frequently with larger cysts. Maximal cyst diameter >4.05cm was predictive of ovarian loss with 78% sensitivity and 64% specificity (AUC=0.67, 95%CI=0.54–0.81, P=0.04), while maximal cyst diameter >4.55cm was predictive of undergoing surgical exploration with 83% sensitivity and 82% specificity (AUC=0.86, 95%CI=0.77–0.96, P< 0.001).

Conclusion: In this series, almost 1 in 3 perinatal ovarian cysts were associated with loss of the involved ovary, with at least half of these events occurring prenatally. Complex cysts, particularly those seen postnatally, and those greater than 4 cm in maximal diameter appear to have higher rates of ovarian loss. Surgical cystectomy occurs more frequently in cysts greater than 4.5 cm but the impact of such operations, or more aggressive in-utero interventions, on preventing ovarian loss remains unclear. The long-standing recommendation to intervene immediately with surgery in a newborn with a large ovarian cyst may need reassessment.