Successful Preterm Delivery of a Fetus with High-risk Sacrococcygeal Teratoma Based on Fetal Echocardiographic Findings

Abstract

A solid giant sacrococcygeal teratoma (SCT) may cause high-output heart failure in a fetus. The mortality rate increases with the development of fetal hydrops. In this study, we report a case of a rapidly growing fetal SCT, in which early delivery was carried out based on fetal echocardiography findings. Tumor resection immediately after delivery resulted in survival of the baby. The mother was referred to our hospital at 19 weeks of gestation. The tumor length increased rapidly from 11.2 cm at 29 weeks to 15.6 cm at 30 weeks. Fetal magnetic resonance imaging showed a large, predominantly solid type of SCT without extension into the pelvic space (Altman type I). At 30 weeks, the fetal combined cardiac output was elevated to 1,350 mL/kg/min, but no signs of hydrops were observed. After repeated evaluation with fetal echocardiography, a cesarean section was conducted at 32 weeks and 3 days. This decision was based on progressive cardiomegaly, development of right ventricular dysfunction and tricuspid regurgitation, and abnormal distribution of cardiac output. Intervention timing plays a critical role in the survival of a fetus with high-risk SCT, and repeated echocardiographic evaluation of the fetal cardiovascular dynamics is essential.