Tumor volume to fetal weight ratio as an early prognostic classification for fetal sacrococcygeal teratoma

Rodríguez, M. Acosta; Cass, Darrell L.; Lazar, David A.; Cassady, Christopher I.; Moise, Kenneth J.; Johnson, Anthony; Mushin, Oren P.; Hassan, Saif F.; Belleza-Bascon, Bella; Olutoye, Oluyinka O.

doi:10.1016/j.jpedsurg.2011.03.051

Cited by 55 publications

(41 citation statements)

References 25 publications

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“…This is similar to previous findings presented by Rodriguez et al showing that fetuses with an adverse outcome had significantly larger tumor size to fetal weight ratios prior to gestational week 24 [24].…”

Section: Accepted Manuscriptsupporting

confidence: 92%

Sacrococcygeal teratoma: A population-based study of incidence and prenatal prognostic factors

Hambraeus

Arnbjörnsson

Börjesson

et al. 2016

Journal of Pediatric Surgery

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Section: Accepted Manuscriptsupporting

confidence: 92%

Sacrococcygeal teratoma: A population-based study of incidence and prenatal prognostic factors

Hambraeus

Arnbjörnsson

Börjesson

et al. 2016

Journal of Pediatric Surgery

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“…TFR was calculated similarly to previously described with the exception that we evaluated the internal and external components separately and then summed the volumes of both [10]. The volumes of both the internal and external components were calculated using a formula for an ellipsoid.…”

Section: Methodsmentioning

confidence: 99%

“…High TFR before 24 weeks has been associated with poorer perinatal outcome in a small cohort of 10 patients and again in a multicenter study that included the original cohort [10, 12]. We sought to evaluate the ability of TFR to predict poor fetal outcome and increased maternal operative risk in our large cohort of fetuses with SCT.…”

Section: Introductionmentioning

confidence: 99%

High Tumor Volume to Fetal Weight Ratio Is Associated with Worse Fetal Outcomes and Increased Maternal Risk in Fetuses with Sacrococcygeal Teratoma

Gebb¹,

Khalek²,

Qamar³

et al. 2018

Fetal Diagn Ther

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Objective: Tumor volume to fetal weight ratio (TFR) > 0.12 before 24 weeks has been associated with poor outcome in fetuses with sacrococcygeal teratoma (SCT). We evaluated TFR in predicting poor fetal outcome and increased maternal operative risk in our cohort of SCT pregnancies. Methods: This is a retrospective, single-center review of fetuses seen with SCT from 1997 to 2015. Patients who chose termination of pregnancy (TOP), delivered elsewhere, or had initial evaluation at > 24 weeks were excluded. Receiver operating characteristic (ROC) analysis determined the optimal TFR to predict poor fetal outcome and increased maternal operative risk. Poor fetal outcome included fetal demise, neonatal demise, or fetal deterioration warranting open fetal surgery or delivery < 32 weeks. Increased maternal operative risk included cases necessitating open fetal surgery, classical cesarean delivery, or ex utero intrapartum treatment (EXIT). Results: Of 139 pregnancies with SCT, 27 chose TOP, 14 delivered elsewhere, and 40 had initial evaluation at > 24 weeks. Thus, 58 fetuses were reviewed. ROC analysis revealed that at ≤24 weeks, TFR > 0.095 was predictive of poor fetal outcome and TFR > 0.12 was predictive of increased maternal operative risk. Conclusion: This study supports the use of TFR at ≤24 weeks for risk stratification of pregnancies with SCT.

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“…97 Other reported predictors include a ratio of tumor volume to fetal weight of 0.12 or more, tumors with mostly solid rather than cystic elements, rapid tumor growth, impaired fetal cardiac function or cardiomegaly, and the development of complications such as hydramnios or the mirror syndrome (maternal features of preeclampsia mirroring fetal hydrops). 96,98,99 The development of hydrops at a gestational age at which neonatal survival is likely usually prompts delivery, whereas impending hydrops in an immature fetus raises the possibility of fetal therapy. Current interventions include open fetal surgical debulking, shunt placement in large cystic lesions, and radiofrequency ablation, with a wide range of reported survival rates; the high rate of adverse outcomes reported by fetal treatment centers may reflect the increased severity of referred cases.…”

Section: Fetal Tumorsmentioning

confidence: 99%

Fetal Surgery

Wenstrom

Carr

2014

Obstetrics &Amp; Gynecology

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Since the first human fetal surgery was reported in 1965, several different fetal surgical procedures have been developed and perfected, resulting in significantly improved outcomes for many fetuses. The currently accepted list of fetal conditions for which antenatal surgery is considered include lower urinary tract obstruction, twin-twin transfusion syndrome, myelomeningocele, congenital diaphragmatic hernia, neck masses occluding the trachea, and tumors such as congenital cystic adenomatoid malformation or sacrococcygeal teratoma when associated with developing fetal hydrops. Until recently, it has been difficult to determine the true benefits of several fetal surgeries because outcomes were reported as uncontrolled case series. However, several prospective randomized trials have been attempted and others are ongoing, supporting a more evidence-based approach to antenatal intervention. Problems that have yet to be completely overcome include the inability to identify ideal fetal candidates for antenatal intervention, to determine the optimal timing of intervention, and to prevent preterm birth after fetal surgery. Confronting a fetal abnormality raises unique and complex issues for the family. For this reason, in addition to a maternal-fetal medicine specialist experienced in prenatal diagnosis, a pediatric surgeon, an experienced operating room team including a knowledgeable anesthesiologist, and a neonatologist, the family considering fetal surgery should have access to psychosocial support and a bioethicist.

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Tumor volume to fetal weight ratio as an early prognostic classification for fetal sacrococcygeal teratoma

Cited by 55 publications

References 25 publications

Sacrococcygeal teratoma: A population-based study of incidence and prenatal prognostic factors

Sacrococcygeal teratoma: A population-based study of incidence and prenatal prognostic factors

High Tumor Volume to Fetal Weight Ratio Is Associated with Worse Fetal Outcomes and Increased Maternal Risk in Fetuses with Sacrococcygeal Teratoma

Fetal Surgery

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