Sacrococcygeal fetal teratoma

Relevance: Fetal sacrococcygeal teratoma (SCT) is a serious malformation, and predicting its outcome remains an unsolved problem. SCT is associated with postnatal and antenatal complications. A review of the literature has identified the risk factors for adverse outcomes in fetal SCT; when present, fetal surgery is performed.

Objective: To investigate SCT outcomes and identify and analyze the main factors influencing perinatal outcomes.

Materials and methods: The study included 59 pregnant women with fetal SCT who received perinatal consultation in the V.I. Kulakov NMRC for OG&P over 5 years. The analyzed data included medical history, fetal ultrasound (size, structure, and degree of SCT vascularization, Altman type, tumor volume/fetal weight ratio, and fetal complications), and pregnancy outcomes. In the final part of the study, prenatal factors that could be considered as predictors of disease outcomes were analyzed.

Results: The median gestational age at SCT diagnosis was 19 weeks. There was a predominance of female fetuses (3.5:1). The most common type was type II (56.9%) according to the Altman classification, and the rarest was type III (10.3%). Most SCTs had a predominant solid component (54.2%). Non-immune hydrops fetalis (NIHF) was detected in eight (13.6%), cardiomegaly in 16 (27.6%), and polyhydramnios in 23 (39%) cases. In 38 (64.4%) cases, live births occurred, including 29 (76.3%) by caesarean section and 9 (23.7%) by vaginal delivery. Adverse prenatal risk factors included solid SCT structure and pronounced tumor vascularization, which led to the development of NIHF and cardiomegaly (p<0.005). Tumor volume/fetal weight ratio >0.12 was more than three times more common in the adverse outcome group (76.9% vs. 21.4%).

Conclusion: Early detection of SCT, predominance of the solid component and abundant vascularization of SCT, and tumor volume/fetal weight ratio >0.12 before 24 weeks of gestation, can be considered as predictors of poor outcome.