ABSTRACT
BACKGROUND: Large, prenatally diagnosed sacrococcygeal teratomas (SCTs) present a formidable challenge because of their unpredictable growth and propensity for complications. In our experience, even with aggressive serial imaging, many fetuses have died under a policy of "watchful waiting." We propose "early delivery" as the best option for selected cases of high-risk fetal SCT. METHODS: The medical charts of all fetuses with SCT followed up at our institution and delivered before 32 weeks of gestation were reviewed for radiologic findings, fetal interventions, delivery information, perinatal inpatient course, and autopsy or discharge report. RESULTS: Between 1996 and 2009, excluding those that underwent fetal surgery, 9 patients with fetal SCT were delivered before 32 weeks of gestation. Four had type I tumors, and 5 had type II tumors. Of the 9 fetuses, 4 survived the neonatal period. The only surviving patient delivered before 28 weeks underwent an ex utero intrapartum therapy procedure. CONCLUSIONS: A significant number of pregnancies complicated by high-risk SCT will manifest signs of fetal or maternal decompensation, or both, between 27 and 32 weeks of gestation. In the absence of fulminant hydrops, preemptive early delivery can be associated with surprisingly good outcomes in appropriately selected fetuses with high-risk SCT.
Subject(s)
Cesarean Section , Fetal Therapies , Teratoma/surgery , Cardiac Output, High/embryology , Cardiac Output, High/etiology , Developmental Disabilities/etiology , Fatal Outcome , Female , Gestational Age , Hemorrhage/etiology , Humans , Hydrops Fetalis/etiology , Hydrops Fetalis/prevention & control , Infant, Newborn , Infant, Premature , Male , Obstetric Labor, Premature , Pelvic Neoplasms/congenital , Pelvic Neoplasms/embryology , Pelvic Neoplasms/surgery , Pre-Eclampsia/etiology , Pre-Eclampsia/prevention & control , Pregnancy , Retrospective Studies , Sacrococcygeal Region , Teratoma/congenital , Teratoma/embryology , Ultrasonography, PrenatalABSTRACT
Surgical resections of massive sacrococcygeal teratomas (SCTs) carry significant risk due to baseline hemodynamic instability and the potential for significant hemorrhage. In this case report, a fetus with sacrococcygeal teratoma developed high-output cardiac instability at 32 weeks' gestation. After urgent cesarian delivery, a damage-control operation using Teflon-pledgeted mattress sutures allowed for hemodynamic control of bleeding into the tumor. One week later, after subsequent fluid resuscitation and stabilization, an elective staged resection of the complete mass including the pelvic portion was performed. The patient was discharged home on postoperative day 30 and was doing well at her most recent clinic visit at 30 months of age.
