Clinical Monitoring of Sacrococcygeal Teratoma

Fetal Diagn Ther. 2019;46(5):333-340. doi: 10.1159/000496841. Epub 2019 Mar 20.


Background: Sacrococcygeal teratomas (SCT) are often highly vascularized and may result in high-output cardiac failure, polyhydramnios, fetal hydrops, and demise. Delivery is guided by the SCT to fetus volume ratio (SCTratio), SCT growth rate, and cardiac output indexed for weight (CCOi).

Methods: We compared measurements and outcome in 12 consecutive fetuses referred with SCT. Adverse outcomes were: fetal surgery, delivery < 32 gestational weeks or neonatal demise. Only SCTratio and CCOi were used to manage the cases. SCT vascularization index (VI%) was derived from the 3D virtual organ computer-aided analysis (VOCAL) software. The SCTModel (modified from acardiac twins) calculated a hypothetical SCT draining vein size and derived a risk line, using diameters of the superior and inferior vena cava, the azygous and umbilical veins. VI% and a model of systemic and umbilical venous volumes (SCTModel) were tested as indicators for outcome in SCT.

Results: Fetuses were monitored from 20.1 to 36.4 gestational weeks and 5/12 had adverse outcomes: 1 had successful open fetal surgery at 23.8 weeks and delivered at term, 4 delivered at < 32 weeks with 3/4 having neonatal demise between 25 and 29 weeks. VI% was significantly higher in cases with adverse outcomes (mean 10.3 [8.9-11.6] vs. 4.4 [3.4-5.3], p < 0.0001). The additional fraction of the fetal cardiac output required to perfuse the SCT-draining vein (XSCO%) (p = 0.46), SCTratio (p = 0.08), and CCOi (p = 0.64) were not significant. All cases with adverse outcome had VI% > 8%. The SCTModel risk line predicted nonadverse outcomes well but lacked data in 2/5 cases with adverse outcomes.

Conclusions: VI% is a significant indicator of SCT cases with adverse outcomes and combined with SCTratio may guide timing of delivery better than current measures.

Keywords: Cardiovascular pathophysiology; Fetal surgery; Hydrops; Sacrococcygeal teratoma; Umbilical/venous diameter ratio; Vascularization index.

Publication types

  • Comparative Study

MeSH terms

  • Clinical Decision-Making
  • Decision Support Techniques*
  • Female
  • Fetal Death
  • Fetal Monitoring / methods*
  • Fetal Therapies
  • Gestational Age
  • Humans
  • Models, Cardiovascular
  • Patient Selection
  • Predictive Value of Tests
  • Pregnancy
  • Premature Birth / mortality
  • Regional Blood Flow
  • Reproducibility of Results
  • Risk Assessment
  • Risk Factors
  • Sacrococcygeal Region
  • Spinal Neoplasms / blood supply*
  • Spinal Neoplasms / diagnostic imaging*
  • Spinal Neoplasms / mortality
  • Spinal Neoplasms / surgery
  • Teratoma / blood supply*
  • Teratoma / diagnostic imaging*
  • Teratoma / mortality
  • Teratoma / surgery
  • Term Birth
  • Treatment Outcome
  • Ultrasonography, Doppler*
  • Ultrasonography, Prenatal*