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American Academy of Pediatrics
Complex Fetal Care

Fetal Sacrococcygeal Teratoma and the Development of Hydrops

Katelin P. Kramer, Shilpa P. Chetty, Hythem Nawaytou, Lan Vu and Elizabeth E. Rogers
NeoReviews February 2021, 22 (2) e141-e147; DOI: https://doi.org/10.1542/neo.22-2-e141
Katelin P. Kramer
*Departments of Pediatrics,
§University of California, San Francisco, Benioff Children’s Hospital, San Francisco, CA
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Shilpa P. Chetty
†Obstetrics/Gynecology and Reproductive Sciences, and
§University of California, San Francisco, Benioff Children’s Hospital, San Francisco, CA
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Hythem Nawaytou
*Departments of Pediatrics,
§University of California, San Francisco, Benioff Children’s Hospital, San Francisco, CA
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Lan Vu
‡Surgery, University of California, San Francisco, CA
§University of California, San Francisco, Benioff Children’s Hospital, San Francisco, CA
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Elizabeth E. Rogers
*Departments of Pediatrics,
§University of California, San Francisco, Benioff Children’s Hospital, San Francisco, CA
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  • Abbreviations:
    CVO:
    combined ventricular output
    DVP:
    deepest vertical pocket
    EXIT:
    ex utero intrapartum therapy
    FTC:
    Fetal Treatment Center
    MCA:
    middle cerebral artery
    MRI:
    magnetic resonance imaging
    NTD:
    neural tube defect
    PPROM:
    preterm premature rupture of membranes
    RFA:
    radiofrequency ablation
    SCT:
    sacrococcygeal teratoma
    TFR:
    tumor volume–to–fetal weight ratio
    UCSF:
    University of California, San Francisco
  • Case Presentation

    A large sacrococcygeal teratoma (SCT) was detected on routine 18-week fetal ultrasonography in a 26-year-old, gravida 2, para 0 woman. She had a history of Helicobacter pylori gastric infection and an ovarian cyst, in addition to a previous spontaneous abortion at 15 weeks’ gestation. This pregnancy had been uncomplicated and prenatal laboratory testing was unremarkable. She was evaluated at an outside fetal care center at 21 weeks’ gestation. At that time, the fetal SCT measured 5.9×5.3 cm of mixed solid and cystic components, about 30% to 50% of the fetal size. Given the size of the SCT, with interval growth from initial diagnosis, she was referred to the University of California, San Francisco (UCSF) Fetal Treatment Center (FTC) to discuss the options for fetal surgical intervention.

    The woman was seen at the UCSF FTC at 23 weeks’ gestation. Imaging at that time included fetal ultrasonography and fetal echocardiography. Ultrasonography (Fig 1) demonstrated a largely exterior SCT with a small, presacral component. The tumor was largely solid with small cystic components and classified as an SCT type 1 lesion. The dimensions were 11.6×10.5×9.6 cm with an estimated volume of 611 mL, about 87% of the fetal size. There was no evidence of polyhydramnios, with the deepest vertical pocket (DVP) at 7.7 cm. Fetal echocardiography showed normal cardiac anatomy with significant dilation of the inferior vena cava and mild cardiomegaly with a cardiothoracic ratio of 0.36. The combined ventricular output (CVO) was significantly elevated at 817 mL/kg per minute (upper limit of normal is 500 mL/kg per minute). Diastolic flow velocity in the umbilical artery (systolic-to-diastolic velocity ratio of 6.2) was low, possibly secondary to a “steal phenomenon” to the tumor. The middle cerebral artery (MCA) diastolic flow velocity was also low, suggestive of cerebral vasodilation to maintain cerebral blood flow (brain-sparing). …

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    1 Feb 2021
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    Fetal Sacrococcygeal Teratoma and the Development of Hydrops
    Katelin P. Kramer, Shilpa P. Chetty, Hythem Nawaytou, Lan Vu, Elizabeth E. Rogers
    NeoReviews Feb 2021, 22 (2) e141-e147; DOI: 10.1542/neo.22-2-e141

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    Fetal Sacrococcygeal Teratoma and the Development of Hydrops
    Katelin P. Kramer, Shilpa P. Chetty, Hythem Nawaytou, Lan Vu, Elizabeth E. Rogers
    NeoReviews Feb 2021, 22 (2) e141-e147; DOI: 10.1542/neo.22-2-e141
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