Download PDF
AJP Rep 2015; 05(01): e77-e79
DOI: 10.1055/s-0035-1547332
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Use of External Cephalic Version and Amnioreduction in the Delivery of a Fetal Demise with Macrocephaly Secondary to Massive Intracranial Teratoma

Matthew J. Blitz
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
,
Elizabeth Greeley
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
,
Hima Tam Tam
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
,
Burton Rochelson
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
› Author Affiliations
Further Information

Publication History

07 January 2015

23 January 2015

Publication Date:
26 March 2015 (online)

   Permissions and Reprints

Abstract

Introduction Congenital intracranial tumors are rare and often incidentally diagnosed on routine ultrasound. We report a case of a fetal demise with a massive intracranial teratoma at 25 weeks of gestation and the management of her delivery in the setting of macrocephaly, breech presentation, and polyhydramnios.

Case A 31-year-old G3P1011 woman at 25 weeks' gestation presented with a recent fetal demise and a fetal intracranial tumor first identified at 16 weeks' gestational age. The patient had declined termination of pregnancy. Biometry was consistent with 24 weeks' gestation, except for a head circumference of 394.4 mm consistent with 39 weeks' gestation. The fetus was in a breech presentation. An external cephalic version (ECV) was successfully performed under epidural anesthesia and an amnioreduction was then performed to stabilize the fetal position. Immediate induction of labor and vaginal delivery followed.

Discussion ECV and amnioreduction may help facilitate delivery in cases of fetal demise complicated by macrocephaly, malpresentation, and polyhydramnios.

Keywords

fetal brain tumor - intracranial teratoma - prenatal diagnosis - external cephalic version - amnioreduction
 

  • References

  • 1 Manoranjan B, Provias JP. Congenital brain tumors: diagnostic pitfalls and therapeutic interventions. J Child Neurol 2011; 26 (5) 599-614
    CrossrefPubMedGoogle Scholar
  • 2 Chien YH, Tsao PN, Lee WT, Peng SF, Yau KI. Congenital intracranial teratoma. Pediatr Neurol 2000; 22 (1) 72-74
    CrossrefPubMedGoogle Scholar
  • 3 Koizumi K, Abe E, Kusanagi Y, Ito M. Giant immature intracranial teratoma with antenatal cranial perforation. J Obstet Gynaecol Res 2010; 36 (6) 1252-1255
    CrossrefPubMedGoogle Scholar
  • 4 Saada J, Enza-Razavi F, Delahaye S, Martinovic J, Macaleese J, Benachi A. Early second-trimester diagnosis of intracranial teratoma. Ultrasound Obstet Gynecol 2009; 33 (1) 109-111
    CrossrefPubMedGoogle Scholar
  • 5 Goffinet F, Carayol M, Foidart JM , et al; PREMODA Study Group. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol 2006; 194 (4) 1002-1011
    CrossrefPubMedGoogle Scholar
  • 6 Chasen ST, Chervenak FA, McCullough LB. The role of cephalocentesis in modern obstetrics. Am J Obstet Gynecol 2001; 185 (3) 734-736
    CrossrefPubMedGoogle Scholar
  • 7 Dickinson JE, Tjioe YY, Jude E, Kirk D, Franke M, Nathan E. Amnioreduction in the management of polyhydramnios complicating singleton pregnancies. Am J Obstet Gynecol 2014; 211 (4) 434.e1-434.e7
    CrossrefPubMedGoogle Scholar