The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, PA, USA.
J Pediatr Surg. 2011 Jul;46(7):1325-32. doi: 10.1016/j.jpedsurg.2010.10.020.
Large, prenatally diagnosed sacrococcygeal teratomas (SCTs) present a formidable challenge because of their unpredictable growth and propensity for complications. In our experience, even with aggressive serial imaging, many fetuses have died under a policy of "watchful waiting." We propose "early delivery" as the best option for selected cases of high-risk fetal SCT.
The medical charts of all fetuses with SCT followed up at our institution and delivered before 32 weeks of gestation were reviewed for radiologic findings, fetal interventions, delivery information, perinatal inpatient course, and autopsy or discharge report.
Between 1996 and 2009, excluding those that underwent fetal surgery, 9 patients with fetal SCT were delivered before 32 weeks of gestation. Four had type I tumors, and 5 had type II tumors. Of the 9 fetuses, 4 survived the neonatal period. The only surviving patient delivered before 28 weeks underwent an ex utero intrapartum therapy procedure.
A significant number of pregnancies complicated by high-risk SCT will manifest signs of fetal or maternal decompensation, or both, between 27 and 32 weeks of gestation. In the absence of fulminant hydrops, preemptive early delivery can be associated with surprisingly good outcomes in appropriately selected fetuses with high-risk SCT.
大型、产前诊断的尾骨尾部畸胎瘤（SCT）因其不可预测的生长和并发症倾向而构成巨大挑战。根据我们的经验，即使采用积极的连续影像学检查，许多胎儿在“静观其变”的政策下还是死亡了。我们提出“早期分娩”作为高危胎儿 SCT 选定病例的最佳选择。
回顾分析了在我院接受随访并在 32 周前分娩的所有 SCT 胎儿的病历，以了解其放射学发现、胎儿干预、分娩信息、围产期住院过程以及尸检或出院报告。
1996 年至 2009 年期间，排除接受胎儿手术的病例，有 9 例胎儿 SCT 在 32 周前分娩。4 例为 I 型肿瘤，5 例为 II 型肿瘤。9 例胎儿中，有 4 例在新生儿期存活。唯一在 28 周前分娩并接受宫外产时治疗的存活患者。
在 27 至 32 周之间，大量伴有高危 SCT 的妊娠将表现出胎儿或母体失代偿的迹象，或两者兼而有之。在没有暴发性水肿的情况下，对于高危 SCT 的适当选择的胎儿，提前进行早期分娩可带来出人意料的良好结局。
