Our obstetrics and gynecology departments are all women’s affairs and do not seem to be profound. Even ordinary people know nine times out of ten of the names of many diseases, such as hysteromyoma and ovarian cyst, which are common gynecological diseases for adult women.
However, you may not have heard of it. Female babies who are still in their mothers’ stomachs may also suffer from ovarian cysts.
Will the child stay or not?
On the Internet, there are also friends who take such cases to consult my opinion. They are all expectant mothers who are 6 ~ 7 months pregnant and find cysts on the ovaries of the fetus in routine B-ultrasound examination. The local doctor suggested induced labor, and the child in the belly has fetal movement, which is a lively and spilt life. The mother is really reluctant to give up, so she asked me for help.
On such a question, I went through Chinese textbooks on obstetrics and gynecology, including several brick-thick classic books on obstetrics and gynecology, and found no discussion or guidance on this issue. Asked my colleagues, I also said that I had no experience in what and had to look up the literature before I knew.
Search medical literature on Pubmed. Generally speaking, the number of cases reported abroad is not very large, and the general opinion is that observation can be continued and induction of labor is not necessary.
I still don’t know in my heart. I think of a book I participated in translating before. I dug it up and studied it carefully, and finally found the answer. The book states as follows:
In routine ultrasound examination during pregnancy, the incidence rate of fetal ovarian cyst is 30% ~ 70%, but the real situation is difficult to know exactly.
The cause of the disease is not clear, and it is most likely due to the double influence of gonadotropins from the mother and fetus. If the pregnant mother is complicated with preeclampsia, diabetes and polyhydramnios, the probability of fetal cyst increases.
Generally speaking, simple cysts can disappear naturally before or after childbirth, and the treatment strategy is mainly observation. If the cyst exceeds 6 cm, in order to prevent dystocia caused by rupture during childbirth or excessive fetal abdomen, cesarean section is recommended to terminate pregnancy, and small cysts can be delivered naturally through vagina.
Fetal ovarian cysts usually disappear naturally 4 months after delivery. Mothers need not worry too much, but they should follow up the baby regularly. If the cyst does not disappear or increases progressively, medical intervention may be required.
For most of the people who came to consult, the size seen on B-ultrasound did not exceed 6cm. I generally gave a reply of [continue to observe]. One after another, there were continuous patient consultations and feedback from patients.
Indeed, the vast majority of fetal ovarian cysts disappear within half a year after birth or within half a year after birth, and I am even more confident.
A letter from my mother
On this issue, I also received such a thank-you letter:
Dr. Zhang,
Because I met you, I have the feeling of happiness now.
When I was pregnant, I was very afraid to find out the fetal ovarian cyst. The doctors here had not seen it before. Let me induce labor, because I really couldn’t bear to give up the baby who already had fetal movement. I consulted you. You answered my N incoherent questions very carefully and patiently. After listening to your explanation, I decided to give birth to the baby.
Now the baby is very healthy. I named her [Rui Yu]. [Rui] is my name, which also means auspicious. [Yu] is to let her always remember Dr. Zhang Yu, her benefactor and the noble of our family. I also hope that when the child grows up, he can become a person who brings hope to others.
The moment I finished reading this letter, my face was full of brilliant and happy silly music.
Although the mother of the child regards me as the benefactor of the child, in fact, it is her parents who have to thank her in the end. Through communication with the doctor, she bravely left her behind.
Before the birth of the child, from the communication with the mother of the child, I can feel her anxiety and worry, and I can realize that she especially wants to hear 100% exact answers from me, such as [the baby will be fine when it is born].
As a doctor, I can never make a 100% guarantee. I must take one step at a time and provide psychological support unconditionally. Objectively, I must inform all possible adverse consequences. The final right to choose will always be with the parents of the children.
The child’s mother said in the letter: Dr. Zhang, you are the boat crossing our family.
In fact, is this brave mother not in the same boat with me?
Life, there is no perfect answer
When a doctor gives advice on induced labor at such a moment, it seems that he will never make mistakes, will not lead to lawsuits, and will not complain. After all, he is a [problematic] child. At most, the patient will feel unlucky, or complain about the injustice of heaven, and will bear everything silently.
However, in the face of life, conscience and the medical and humanistic education received in Concorde for many years, a qualified doctor has no choice but to bear some responsibility.
In the face of a life’s future, when a mother is in a dilemma, she will hardly have a perfect countermeasure and a 100% definite answer. After all, what one pursues in one’s life can only be without complaint or regret. Life is so changeable that one must show a little spirit of willing to accept defeat, so one can carry forward with one’s income and hope without hesitation.
As a doctor, in addition to refining his business, he should also take on some responsibilities, as Kant said:
There are two things, the more often and persistently we think about them, the more we fill our hearts with ever-changing admiration and awe. They are the starry sky above me and the moral law in my heart.