Your Baby and Cystic Hygromas

Cystic Hygromas are common congenital abnormalities which occur in approximately 1 out of every 100 live births. They are characterized by abnormal growth of cells or tissue within the body. Cysts may develop in any part of the body, but they most commonly affect the skin, bones, heart valves and blood vessels. There are two types: Separated (or septic) and Unaffected (unrelated). Cystic hygromas are usually caused by genetic factors. Other causes include infection, trauma, infections during pregnancy and birth complications such as premature rupture of membranes. Some women with cystic hygromas have no other risk factors for developing them. However, some women do develop these conditions after having children. The following table gives some statistics about the prevalence of cystic hygromas in different populations.

Population Prevalence (%) Congenital Cystic Hygroma 1.0% Pregnancy Loss 0.4% Birth Defects 2.5% Premature Ectopic Pregnancy 0.6% Infections 4.3% Postpartum Depression 3.7% Alcoholism 5.1% Obesity 6.2% Diabetes 7.8% Smoking 9.2%

The following table gives some characteristics of women with cystic hygromas compared to women without them.

Characteristic Cystic Hygromas No Cystic Hyaemorrhagia Yes No History of bleeding during pregnancy. 2.4% 1.1% Multiple Pregnancy Losses 0.6% 0.3%

The following table gives some characteristics of women with cystic hygromas who have also experienced other complications.

Complication Prevalence (%) Ectopic Pregnancy 0.2% Cervical Cerclage 0.2% Obesity 1.4% Obstructed Labour 2.5% Preterm Previa 1.0% Preeclampsia 3.5%

Some women with these conditions have no symptoms, or only experience mild symptoms such as headache and fatigue. Your doctor may find these lesions during a routine examination of your abdomen. Other times, the growths may be found during a scan for a different reason. In rare cases, a cyst grows so large that it causes discomfort or pain.

A cyst may bleed if it becomes stretched or damaged. The cysts contain blood, which is why they appear red or pink in colour under the skin. Some cysts may contain mature muscle tissue. They are then known as rhabdomyomas. Though rare, some women may also experience changes in their menstrual cycle. This may be due to hormonal imbalances that cysts cause.

The following table gives the most common types of pregnancy complications that women with cystic hygromas experience.

Complication Prevalence (%) Ectopic Pregnancy 0.2% Cervical Cerclage 0.2% Preeclampsia 3.5%

Complications of this condition are rare, but can include:

– Fatigue: Due to the cysts causing your blood to become thicker.

– Premature birth: Cysts may cause your baby to grow too quickly. The extra pressure on your abdomen can also cause your baby to become distressed and be born too early.

– Miscarriage: In severe cases, some cysts may grow so quickly that they cause your pregnancy to end naturally.

– Haemorrhaging (heavy bleeding): You may experience heavy bleeding during your first trimester or even in later pregnancies. This is because cysts cause a hormone imbalance, which can lead to increased blood flow to your uterus.

– Pain: Cysts can also cause pain in your abdomen as they grow if the cyst presses on your other internal organs.

The likelihood of experiencing these complications is related to how many cysts you have and how severe they are.

The cause of cystic hygromas is not known. Some factors that may increase the risk are:

– Age: Congenital cystic hygromas are more common in teenagers and the elderly.

– Family history: If your mother or sister has had one, you are more likely to have them.

– Multiple pregnancies: Having more than one pregnancy in the past increases the likelihood of having a cystic hygroma.

– Obesity

If you have cystic hygromas, you may wish to consider genetic testing to see if you have an increased risk of other genetic conditions.

3. Management

3.1. Treatments

There is currently no known cure for cystic hygromas, and as such treatment focuses more on relieving any pain or complications that may arise. Most women with cystic hygromas will never experience any complications beyond excessive male hormone production (causing problems with the menstrual cycle). The options for treating or managing complications are detailed below.

3.1.1. Expectant Management

If your cystic hygromas are small and asymptomatic, your doctor may suggest that you undergo an expectant management plan, which involves regular monitoring of the cysts via ultrasound scans. This option is usually only suitable for women with small cysts that appear in isolation.

3.1.2. Medical Treatments

If you experience pain or other complications, your doctor may prescribe various medications to help relieve and prevent any issues.

Oral Contraceptives: Taken daily, this medication prevents ovulation and the thickening of the uterine lining, both of which are triggered by the release of ovarian cyst-related hormones. It contains a very low dose of the hormones in the combined pill, which prevents ovulation in most women who take it. It is possible to take this medication while breastfeeding.

Progestagen Only Pills: This type of contraceptive prevents ovulation and is sometimes prescribed during an expectant management plan or if a woman cannot take combined hormonal contraceptives.

GnRH Agonist: These medications act by suppressing the release of hormones by the pituitary gland and the ovaries. This medication can be taken either daily or as an injection given by a healthcare professional every two to three months.

Antiandrogens: These drugs work by blocking the action of male (and in this case female) hormones on particular organs. They are effective at treating pain, and in some cases may prevent the need for surgery. The medication can either be taken daily or as an injection given by a healthcare professional every two to three months.

3.1.3. Surgical Treatments

If your cysts cause complications that require immediate medical attention, then surgery may be necessary to remove them. The surgical options available and the methods used will vary depending on the number, size and location of your cysts. Your doctor will speak to you about the specifics of your situation and your surgery will be scheduled accordingly.

Some surgical approaches include:

Laparoscopy: A laparoscopy is a minor surgery that can be performed with local anaesthetic and uses a few small incisions using a telescope-like device called a laparoscope. The cysts can then be drained and the fluid can be tested to confirm the diagnosis. If an abnormality is found during the surgery, your surgeon may choose to remove the lining of your uterus (endometrium) as well.

Myomectomy: Myomectomy is the surgical removal of fibroids from the uterus. Multiple approaches may be taken to achieve this, depending on the location and size of the fibroids.

Salpingectomy: Salpingectomy is a surgical procedure that removes one or both fallopian tubes. It is usually performed when the fallopian tubes contain fibroids or have been partially destroyed by trauma or infection.

3.1.4. Miscarriage Risk

Exposure to high levels of male hormones may cause early miscarriage (chemical pregnancy). If you fear that your male partner may have high levels of these hormones, you may like to consider fertility therapies that will encourage your body to produce more of its own progesterone.

As with many aspects of this disorder, more research is needed before we have a solid understanding of the causes and how to treat them.

4.0. Questions and Answers

I have been diagnosed with PCOS, but I’m not sure what to do about it. There are so many different types of treatment and they all have their own side effects. I don’t know how to decide what will be best for me.

It’s normal to feel confused. It can be overwhelming when you first receive a diagnosis, especially one as complex as PCOS. But don’t worry! We’re here to help guide you towards a treatment plan that will suit your specific needs.

Firstly, it is important that you seek a second opinion from another medical professional with experience in diagnosing and treating PCOS. If possible, ask friends or family for recommendations. Look for a medical professional who has a specialty in reproductive health, endocrinology or gynaecology.

Why do I need to see another doctor?

Many doctors have some knowledge of PCOS, but not all have treated many patients for it. A second opinion will give you the opportunity to ask more specific questions relating to your own condition and treatment options. You doctor will also be able to perform any necessary tests in order to make a diagnosis.

My doctor says I need to lose weight, but I’ve tried everything and can’t manage it. Help!

Many women with PCOS find that they gain weight easily, especially around their tummy. This happens because the body isn’t processing sugar in the normal way and is storing it in fat cells. But don’t worry, there are ways that you can lose this extra weight.

The most important thing is that you find a treatment that works for you. For some people, going low-carb and eating more protein and fat is the best option. For others, a higher carb, lower fat diet is better. Experiment with what works for you.

If one diet isn’t working for you, there are other options such as joining a support group or seeing a dietician for specialized advice.

How can I reduce the androgen hormones in my body?

The most common way of reducing androgen hormones is through the use of birth control pills or an IUD. These medications work by overloading the liver with other chemicals so that it cannot process male hormones properly.

There are also some herbs and supplements that may help. However, it is important to remember that none of these have been studied extensively and there are no guarantees of safety or efficacy.

Some options include:

Spironolactone: A common treatment for PCOS, this medication comes in the form of a pill or cream. It can occasionally cause some liver problems and people with a history of stomach or intestine ulcers should not take it.

Dioscorea: A plant commonly known as yam, this may improve liver function and help to regulate hormone production.

Fenugreek: Another supplement that is believed to improve liver function. It can be hard to find and is quite costly, so it may not be practical for everyone.

Red Raspberry Leaf: Used by many to help alleviate PMS symptoms, this supplement may also help to reduce androgens.

Why have I started growing hair in weird places?

Hirsutism is the medical term for excessive hair growth and it can be a common side effect of having PCOS. It commonly occurs on the chest, abdomen, sides and back. For some women, it can be quite severe and might feel very embarrassing or uncomfortable. If this is the case for you, there are some things that you can do to manage the problem.

Some people find that shaving helps to reduce the appearance of the hair, while others prefer to wax. Epilators can also be used, but may not work as well on coarse hair.

If you have severe pain or ingrown hairs, visit your doctor to find out what treatment options are available for you. Some medications may help to slow the growth of your hair or reduce the amount that grows back after shaving or waxing.

How can I tell if I have Acne?

While PCOS can cause skin problems such as Acne, it is important to remember that having this condition does not automatically mean that you have PCOS. Skin problems can also be caused by a number of other factors including poor diet, stress and certain medications.

The best way to determine what is causing your skin problems is to keep a symptoms diary. Each day, make a note of any factors that might be affecting your skin such as your diet, medications or stress levels. Also make a note of when you experience symptoms such as spots or blemishes. If you have a PCOS diagnosis, keep track of any changes in your body such as new hair growth patterns.

Keeping a symptoms diary allows you to identify what factors cause your skin problems to improve or worsen. For example, if you find that your skin is consistently clear during the summer but starts breaking out in the fall, it may be due to a change in diet. This would be noted in your diary and you could try eliminating peanuts or some other food from your diet to see if it makes a difference.

Some people with Acne find that making simple dietary changes can help to alleviate their skin problems. These include:

Drinking plenty of water.

Eating more fresh fruits and vegetables.

Avoiding foods high in sugar or carbohydrates.

Cutting out food allergens such as peanuts, dairy, eggs, shellfish and soy.

After you’ve made some changes to your diet, keep a close eye on your skin. Note whether or not your skin starts to improve or worsen. If it does improve, keep a close eye on what you’re eating to make sure you don’t unintentionally introduce something that causes you skin to break out again.

Acne can also be treated in a number of other ways including:

Taking supplements such as Niacinamide (a B vitamin), Vitamin A, Vitamin C and Zinc.

Applying essential oils such as Tea Tree Oil.

Applying natural moisturizers such as Aloe Vera.

Taking medications such as antibiotics or birth control pills.

If you feel as though your acne is affecting your life to the point where you’re too embarrassed to leave the house, make an appointment with a dermatologist who can prescribe the best treatment option for you.

How can I ease the pain of headaches and help myself concentrate?

Some women with PCOS experience chronic headaches or migraines. This can be due to a number of factors including fluctuating hormone levels, low blood sugar and dehydration.

In order to alleviate the pain of a headache, try some of the following:

Drink a glass of water and lay horizontal in a dark room.

Apply an ice pack to the back of your neck.

Massage your temples gently.

Take a warm shower or bath.

Try taking an over the counter pain reliever.

If the pain is severe, you should make an appointment with your doctor who will be able to determine whether your headaches are caused by PCOS or if there is an underlying health issue such as an infection or bleeding in the brain.

In addition to headaches, women with PCOS sometimes complain of problems concentrating and short term memory loss.

Sources & references used in this article:

Fetal cystic hygroma: cause and natural history by FA Chervenak, G Isaacson, KJ Blakemore… – … England Journal of …, 1983 – Mass Medical Soc

Cystic hygroma and potential airway obstruction in a newborn: a case report and review of the literature by S Sannoh, E Quezada, DM Merer, A Moscatello… – Cases Journal, 2009 – Springer

Cervical cystic hygroma in the fetus: clinical spectrum and outcome by JC Langer, PG Fitzgerald, D Desa, RA Filly… – Journal of pediatric …, 1990 – Elsevier

Congenital cystic hygroma involving the larynx presenting as an airway emergency. by DM Thompson, JL Kasperbauer – Journal of the National Medical …, 1994 – ncbi.nlm.nih.gov