Peripartum Ultrasound-Guided Drainage of Cystic Fetal Sacrococcygeal Teratoma for the Prevention of the Labor Dystocia: A Report of Two Cases

Abstract

Fetal sacrococcygeal teratoma (SCT) is the most common tumor in the neonatal period and is easily detected by modern ultrasound techniques, mostly during the second-trimester screening. It can cause significant fetal/neonatal morbidity and mortality due to its size, vascular loading, possible rupture, and labor dystocia. Mostly cystic teratomas have favorable prognosis, but if untreated in utero, they may rupture or cause labor obstruction. Cesarean delivery, especially with the vertical incision, increases significantly maternal morbidity due to the hemorrhage and the risk of the uterine rupture in the subsequent pregnancies. The authors report in details two SCT cases with uncomplicated vaginal delivery after peripartum ultrasound-guided drainage of the cystic teratoma. We conclude that the percutaneous emptying of the cystic SCT is an easy, encouraging, safe, and efficient procedure and enables normal vaginal delivery, thus avoiding labor dystocia and possible complications of the cesarean delivery and the risk of tumor rupture.

Keywords

Fetal sacrococcygeal teratoma - prenatal diagnosis - fetal surgery - prevention of dystocia - ultrasound

• References

• 1 Hedrick HL, Flake AW, Crombleholme TM , et al. Sacrococcygeal teratoma: prenatal assessment, fetal intervention, and outcome. J Pediatr Surg 2004; 39: 430-438 ; discussion 430–438
• 2 Makin EC, Hyett J, Ade-Ajayi N, Patel S, Nicolaides K, Davenport M. Outcome of antenatally diagnosed sacrococcygeal teratomas: single-center experience (1993–2004). J Pediatr Surg 2006; 41: 388-393
• 3 Musci Jr MN, Clark MJ, Ayres RE, Finkel MA. Management of dystocia caused by a large sacrococcygeal teratoma. Obstet Gynecol 1983; 62 (3 Suppl) 10s-12s
• 4 Litwiller MR. Dystocia caused by sacrococcygeal teratoma. Two case reports. Obstet Gynecol 1969; 34: 783-786
• 5 Kay S, Khalife S, Laberge JM, Shaw K, Morin L, Flageole H. Prenatal percutaneous needle drainage of cystic sacrococcygeal teratomas. J Pediatr Surg 1999; 34: 1148-1151
• 6 Weston MJ, Andrews H. Case report: in-utero aspiration of sacrococcygeal cyst. Clin Radiol 1991; 44: 119-120
• 7 el-Shafie M, Naylor D, Schaff E, Conrad M, Miller D. Unexpected dystocia secondary to a fetal sacrococcygeal teratoma: a successful outcome. Int J Gynaecol Obstet 1988; 27: 431-438
• 8 Kemp J, Davenport M, Pernet A. Antenatally diagnosed surgical anomalies: the psychological effect of parental antenatal counseling. J Pediatr Surg 1998; 33: 1376-1379
• 9 Patterson LS, O'Connell CM, Baskett TF. Maternal and perinatal morbidity associated with classic and inverted T cesarean incisions. Obstet Gynecol 2002; 100: 633-637
• 10 Crombleholme TM, D'Alton M, Cendron M , et al. Prenatal diagnosis and the pediatric surgeon: the impact of prenatal consultation on perinatal management. J Pediatr Surg 1996; 31: 156-162 ; discussion 162–163