Spontaneous Rupture of Fetal Sacrococcygeal Teratoma

Abstract

With recent advances in technology, fetal sacrococcygeal teratoma is being diagnosed increasingly during the early prenatal period by ultrasound examination. In addition, early detection of tumor related complications such as polyhydramnios, congestive heart failure, hydrops, hemorrhage, urinary tract or bowel obstruction can be followed closely in utero. Active prenatal management can improve fetal perinatal outcome by allowing planned delivery for neonatal surgery [Chisholm, C.A. et al.: Am J Perinatol 1999;16:47–50] or in some cases, fetal intervention. Additionally, families can be counseled appropriately regarding the range of outcomes. We report a case of fetal sacrococcygeal teratoma Type I diagnosed at 20 weeks with a prominent vessel supplying the tumor mass. At 23 weeks, there was a sudden appearance of an additional lobular mass, consistent with intrauterine spontaneous ruptured of a sacrococcygeal teratoma mass.

Sacrococcygeal Teratomas: Prenatal Surveillance, Growth and Pregnancy Outcome

“…Magnetic resonance imaging provides additional information with improved esti- mation of the intrapelvic component compared to ultrasound [9]. These tumors have the potential for rapid growth and need close surveillance [10,11]. Associated malformations are present in 10-40% of the fetuses [4][5][6].…”

Factors associated with poor outcome in fetuses prenatally diagnosed with sacrococcygeal teratoma

“…Fetuses with prenatally diagnosed SCTs have a high risk of death despite fetal interventions which may improve the outcome 9 . The perinatal mortality rate varies between 13% and 50%, and most of these deaths are attributed to cardiac failure, exsanguinating tumor hemorrhage, or both 8,10–13 . Moreover, 9%–24% of the parents choose termination of pregnancy (TOP) 9,14,15 …”

“…9 The perinatal mortality rate varies between 13% and 50%, and most of these deaths are attributed to cardiac failure, exsanguinating tumor hemorrhage, or both. 8,[10][11][12][13] Moreover, 9%-24% of the parents choose termination of pregnancy (TOP). 9,14,15 Factors such as high tumor volume index (TVI), fast SCT growth rate, and predominantly solid, highly vascularized tumors are predictive for poor outcome, defined as prenatal or early neonatal death.…”

“… 9 The perinatal mortality rate varies between 13% and 50%, and most of these deaths are attributed to cardiac failure, exsanguinating tumor hemorrhage, or both. 8 , 10 , 11 , 12 , 13 Moreover, 9%–24% of the parents choose termination of pregnancy (TOP). 9 , 14 , 15 …”

Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas

“…While waiting for nonhydropic fetuses to deliver at later gestational ages, we have observed adverse events in 81% of these pregnancies. As gestation proceeds, there is an increasing risk of preterm labor related to tumor mass and/or polyhydramnios, tumor rupture or hemorrhage, placentomegaly, precipitous hydrops, and maternal mirror syndrome, a preeclamptic condition in which the mother's pathophysiology mirrors that of the hydropic fetus [12,13]. These complications often occur suddenly and are difficult to predict, making the third trimester extremely hazardous for fetuses with high-risk SCT.…”