A neonate with fetal distress and anaemia

Abstract

A baby girl was delivered by emergency caesarean section for fetal bradycardia at 37 weeks' gestation. The 20-week fetal anomaly antenatal scans had showed no obvious abnormalities. At birth the baby looked pale and floppy, needing resuscitation with bag and mask. The Apgar scores were 6 and 8 at 1 and 5 minutes respectively. The baby weighed 1.98 kg. On examination she was noted to be pale with an abdominal mass extending from the left hypochondrium to the right iliac fossa. The initial blood results showed a low haemoglobin of 9.9 g/dl with normal white cell and platelet count. The urea, creatinine, electrolytes, C-reactive protein and liver functions tests were in the normal neonatal range. The Coombs test was negative. There was no evidence of haemolytic anaemia. She received packed cell transfusion for correction of anaemia. An abdominal X-ray showed a paucity of gas in the lower abdomen (Figure 1). Ultrasound of the abdomen and pelvis showed a large pelvic mass with numerous irregular fluid-filled spaces. The liver, biliary tree and the kidneys were normal. A computed tomography scan of the abdomen and pelvis (Figure 2) with contrast showed a 7×5×5 cm low attenuation mass arising from the pelvis and extending into the abdomen, most likely to be right ovarian in origin. Laparotomy showed a large right-sided ovarian cyst with haemorrhagic areas. She underwent right oopherectomy which on macroscopic examination showed multiple blood-filled cysts. Histopathology of the mass suggested a luteinized follicular cyst with no malignant features. She made good postoperative recovery and on follow up at 5 months of age, she was growing and developing normally with no ongoing problems related to the ovarian cyst.