The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics and Gynecology, McGovern Medical School, UTHealth, Houston, Texas, USA,
Department of Obstetrics and Gynecology, Paracelsus Medical University Salzburg, Salzburg, Austria,
Fetal Diagn Ther. 2019;46(5):333-340. doi: 10.1159/000496841. Epub 2019 Mar 20.
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).
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.
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.
VI% is a significant indicator of SCT cases with adverse outcomes and combined with SCTratio may guide timing of delivery better than current measures.
骶尾部畸胎瘤（SCT）通常具有高度的血管化特性，可能导致高输出性心力衰竭、羊水过多、胎儿水肿和死亡。其分娩方式取决于 SCT 与胎儿体积比（SCTratio）、SCT 生长速度以及按体重计算的心脏输出指数（CCOi）。
我们比较了 12 例连续转诊的 SCT 胎儿的测量值和结局。不良结局包括胎儿手术、分娩<32 周或新生儿死亡。仅使用 SCTratio 和 CCOi 来处理这些病例。SCT 血管化指数（VI%）来自于 3D 虚拟器官计算机辅助分析（VOCAL）软件。SCTModel（从无心畸形双胞胎模型修改而来）计算了假设的 SCT 引流静脉的大小，并根据上腔静脉、下腔静脉、奇静脉和脐静脉的直径绘制了一条风险线。VI%和 SCT 系统和脐静脉容积模型（SCTModel）被测试为 SCT 结局的指标。
胎儿被监测 20.1 至 36.4 周，其中 5/12 例出现不良结局：1 例于 23.8 周时行开放式胎儿手术并足月分娩，4 例于<32 周分娩，其中 3/4 例在 25 至 29 周之间新生儿死亡。有不良结局的病例 VI%明显更高（平均值 10.3[8.9-11.6] vs. 4.4[3.4-5.3]，p<0.0001）。额外需要胎儿心输出量的分数来灌注 SCT 引流静脉（XSCO%）（p=0.46）、SCTratio（p=0.08）和 CCOi（p=0.64）无显著差异。所有有不良结局的病例 VI%均>8%。SCTModel 风险线很好地预测了无不良结局，但在 2/5 例有不良结局的病例中缺乏数据。
VI%是 SCT 不良结局病例的重要指标，与 SCTratio 相结合，可能比目前的指标更好地指导分娩时机。
