Sonographic Prognostic Factors in Prenatal Diagnosis of SCT

Abstract

Objective: A subset of fetuses with sacrococcygeal teratomas (SCT) develops hydrops caused by high-output heart failure. Identification of fetuses at risk for hydrops is important because surgical intervention may reverse the pathophysiology of the disease. The aim of this study was to evaluate sonographic prognostic factors regarding tumor morphology and vascularity associated with the development of hydrops in utero. Methods: Over a 10-year period, we identified 7 fetuses with SCT diagnosed antenatally and managed at the University of Mainz. We retrospectively reviewed the charts of mothers and infants and recorded data on prenatal diagnosis, tumor size and localization, perinatal management, neonatal care, and fetal outcome. Results: The diagnosis of SCT was made in all cases by ultrasound. The median gestational age at the time of initial diagnosis was 23 weeks. In 3 cases, signs of fetal heart failure were detected by ultrasound. Pathological blood flow in the venous system was further noted in 2 cases. One fetus developed hydrops. The mean gestational age at delivery was 35 weeks, depending on the presence or absence of maternal or fetal complications. Six infants were delivered by cesarean section, and 1 by vaginal delivery. After fetal stabilization, surgery was performed in 5 of 7 cases. Inadequate ventilation secondary to prematurity was a contributing factor to death in 1 fetus. One fetal intrauterine death occurred at 27 weeks of gestation. Conclusion: Pregnancies with antenatally diagnosed fetal SCT necessitate frequent monitoring to ensure the detection of fetal/maternal complications by ultrasound and Doppler ultrasound. The most important prognostic criteria were cardiomegaly, fetal hydrops, and increased preload indexes of the fetal venous system as sign of fetal heart failure. Many studies show that the occurrence of pulsations in the umbilical vein of a hydropic fetus correlates with a poor fetal outcome. The decision on the optimal time of delivery should therefore be made by a multidisciplinary team of specialists.

Prognostic Role of Tumor-Head Volume Ratio in Fetal Sacrococcygeal Teratoma

“…Predictors of poor fetal outcome include delivery prior to 34 weeks of gestation and development of hydrops [22] . Other factors that negatively impact the prognosis of fetuses with SCT include highly vascular tumor, intratumoral hemorrhage, rapid doubling time or marked increase in size of tumor, tumor size greater than the biparietal diameter of the fetus at the time of diagnosis, predominantly solid tumor, and intra-abdominal extension of tumor [1,5,7,9,11,[23][24][25] .…”

Sacrococcygeal Teratomas: Prenatal Surveillance, Growth and Pregnancy Outcome

“…The in utero surveillance protocol for fetuses identified with SCT is still being defined. Antenatal surveillance by ultrasound and Doppler have identified prognostic criteria such as cardiomegaly, fetal hydrops, and increased preload indexes of the fetal venous system as signs of fetal heart failure [14]. Criteria for in utero therapy are being developed, although evidence-based criteria have been identified for those fetuses requiring maternal fetal surgery with the onset of fetal hydrops at a gestational age earlier than appropriate for delivery and neonatal care.…”

Major Sacrococcygeal Teratoma in an Extreme Premature Infant: A Multidisciplinary Approach

“…Other factors related to poor outcome are highly vascularized, solid tumors over 10 cm in diameter, cardiomegaly and placentomegaly [5,8,10,11,12] . The patient in our case was extremely premature, 27 weeks and 3 days of gestational age, and showed signs of cardiac failure and hydrops, associated with a major, vascularized, solid teratoma over 10 cm.…”

“…Teratomas may bleed severely, or even rupture during a traumatic delivery [9,12,18,19] . Due to the large tumor and to prevent traumatic injury to the infant and the tumor causing severe hemorrhage, a classical upper segment vertical incision was considered.…”