The electronic databases MEDLINE and EMBASE were searched using keywords and word variants for '
ovarian cysts', 'ultrasound' and 'outcome'. The following outcomes in fetuses with a prenatal diagnosis of
ovarian cyst were explored: resolution of the
cyst, change of ultrasound pattern of the
cyst, occurrence of
ovarian torsion and intracystic
hemorrhage, need for postnatal surgery, need for
oophorectomy, accuracy of prenatal ultrasound examination in correctly identifying
ovarian cyst, type of
ovarian cyst at histopathological analysis and intrauterine treatment. Meta-analyses using individual data random-effects logistic regression and meta-analyses of proportions were performed. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale.
RESULTS: Thirty-four studies (954 fetuses) were included. In 53.8% (95% CI, 46.0-61.5%) of cases for which resolution of the
cyst was evaluated (784 fetuses), the
cyst regressed either during pregnancy or after birth. The likelihood of resolution was significantly lower in complex vs simple
cysts (odds ratio (OR), 0.15 (95% CI, 0.10-0.23)) and in
cysts measuring ≥ 40 mm vs < 40 mm (OR, 0.03 (95% CI, 0.01-0.06)). Change in ultrasound pattern of the
cyst was associated with an increased risk of ovarian loss (surgical removal or autoamputation) (pooled proportion, 57.7% (95% CI, 42.9-71.8%)). The risk of
ovarian torsion was significantly higher for
cysts measuring ≥ 40 mm compared with < 40 mm (OR, 30.8 (95% CI, 8.6-110.0)). The likelihood of having postnatal surgery was higher in patients with
cysts ≥ 40 mm compared with < 40 mm (OR, 64.4 (95% CI, 23.6-175.0)) and in complex compared with simple
cysts, irrespective of
cyst size (OR, 14.6 (95% CI, 8.5-24.8)). In cases undergoing prenatal aspiration of the
cyst, rate of recurrence was 37.9% (95% CI, 14.8-64.3%),
ovarian torsion and intracystic
hemorrhage were diagnosed after birth in 10.8% (95% CI, 4.4-19.7%) and 12.8% (95% CI, 3.8-26.0%), respectively, and 21.8% (95% CI, 0.9-40.0%) had surgery after birth.
CONCLUSION: