Sonographic prognostic factors in fetuses with sacrococcygeal teratoma.

BACKGROUND

A subset of fetuses with sacrococcygeal teratoma (SCT) develops hydrops caused by high-output heart failure. Identification of fetuses at risk for hydrops is important because fetal intervention may reverse the pathophysiology of the disease. To date, no reliable sonographic prognostic factors have been identified.

METHODS

An experienced sonologist reviewed the sonographic records of 17 fetuses with SCT referred to the authors' institution. Size of the tumor was measured and corrected for fetal size. The appearance of the tumor (solid versus cystic) and its vascularity were graded on a subjective scale of 1 to 5.

RESULTS

Only 4 of 12 fetuses that had hydrops survived; of the survivors, 3 had undergone fetal intervention. All nonhydropic fetuses survived. Fetuses with hydrops had tumors that were mainly solid and highly vascular, whereas nonhydropic fetuses had predominantly cystic tumors with comparatively less vascularity. There was no significant difference in tumor size between these 2 groups.

CONCLUSIONS

Fetuses with SCT that are mainly solid in appearance and are highly vascularized have a higher risk of getting hydrops in utero. Tumor size is not an independent prognostic factor.