An unusual cause of isolated fetal ascites; fetal ovarian cyst rupture

Fetal ascites can be recognized as a symptom of fetal hydrops, which arise in response to numerous etiologic factors. In contrast, the causes of primary isolated fetal ascites are unclear. Most cases of isolated fetal ascites progress to hydrops fetalis only a bit can resolve spontaneously. In female newborns, ovarian cysts are frequently seen abdominal masses. Usually they are not symptomatic and resolve spontaneously. However, they are rarely symptomatic and they have no clinical significance.
A 34-year-old woman, gravity 2, parity 0, abortion 1 is referred to our clinic at 32 weeks of gestation because of fetal intraabdominal cystic formation. She had an unremarkable prenatal course until this week. In the 32 weeks ultrasonography fetal biometric measurements were compatible with gestational age, amniotic fluid volume was in normal limits. In ultrasonography, we detected a 15mm spheric cystic formation on the left lower side of fetal abdomen. The cystic formation was not related with renal structures and bladder. In Doppler sonography, we did not determine intracystic blood supply. Because the fetus is female and had no accompanying genitourinary and gastrointestinal abnormalities primarily suggested us an ovarian cyst. Patient was called for a new visit two weeks later. In the 34th week, ultrasonography fetal growth was compatible with 34 weeks and amniotic fluid was in normal limits again. Only abdominal circumference was measured as 99% for this week because of fetal intraabdominal fluid. In fetal abdomen, a widespread fluid accumulation was observed. Ovarian cyst on the left fetal ovary was regressed and was measured 14mm with an ellipsoid shape. Intestines were floating in this fluid. Fetal thorax was normal and hydrothorax was notdetermined. We did not observe any edema in subcutaneous tissue and we evaluated as primary fetal ascites even so we performed an assessment about hydrops fetalis. Hemogram, HbA1c, VDRL, TORCH screening, Parvovirus B-19 screening, indirectcoombs test and anticardiolipin IgM and IgG studies were performed for the patient. Karyotyping recommended to patient. However, patient did not accept karyotyping. All screenings were evaluated normal. Fetal echocardiography was normal. Patient was called for a visit two weeks later again. Onthe next examination in the 36th weeks of pregnancy, fetal ultrasonography was completelynormal. We have not observed any fetal ovarian cyst and fluid in fetal abdomen was completelyregressed. Patient had a 3400gr healthy baby on the 40th weeks of her pregnancy.No abnormal finding determined in postnatal abdominal ultrasonography.

Fetal ovarian cyst rupture should be evaluated as an etiological factor in isolatedfetal ascites cases. Evaluation of fetal ovaries is difficult and generally cannot be differentiated from the other pelvic structures. However,when anabdominal detected cystic formation is presented, fetal ovaries should be kept in mind.

Keywords

Fetal ascites, fetal ovarian cyst rupture

	File/Dsecription
	Figure 1 Fetal ascites
	Figure 2 Fetal ovarian cyst
	Figure 3 Regressed fetal ovarian cyst