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  • Title: Fetal hydrops and death from sacrococcygeal teratoma: rationale for fetal surgery.
    Author: Langer JC, Harrison MR, Schmidt KG, Silverman NH, Anderson RL, Goldberg JD, Filly RA, Crombleholme TM, Longaker MT, Golbus MS.
    Journal: Am J Obstet Gynecol; 1989 May; 160(5 Pt 1):1145-50. PubMed ID: 2658603.
    Abstract:
    Most sacrococcygeal teratomas diagnosed before birth can be managed by planned delivery and postnatal surgery. However, large tumors early in gestation may result in placentomegaly, hydrops, and fetal death and a preeclampsia-like syndrome in the mother. This chain of events may result from high output cardiac failure in the fetus caused by arteriovenous shunting through the tumor. We recently encountered this situation in a fetus at 21 weeks' gestation and performed fetal surgery in an attempt to reverse the process. Excision of the teratoma resulted in reversal of hydrops, diminution of descending aortic flow on Doppler echocardiography, and decrease in placental thickness. Despite these changes, uterine irritability after hysterotomy resulted in labor and delivery of a nonviable premature infant. This case demonstrates that when fetal sacrococcygeal teratoma becomes very large early in gestation, high output cardiac failure can endanger both fetus and mother. In the future, use of Doppler echocardiography may allow appropriate selection of high-risk fetuses. Intervention to prevent arteriovenous shunting through the tumor may offer these fetuses an improved chance for survival.
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