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Fetal hydrops and death from sacrococcygeal teratoma: Rationale for fetal surgery

  • Author Footnotes
    * Supported by a fellowship from the Medical Research Council of Canada.
    Jacob C. Langer
    Footnotes
    * Supported by a fellowship from the Medical Research Council of Canada.
    Affiliations
    Fetal Treatment Program, Department of Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Radiology, and Department of Pediatrics, University of California, San Francisco, San Francisco, California
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  • Michael R. Harrison
    Correspondence
    Reprint requests: Michael R. Harrison, MD, HSE 585, University of California, San Francisco, San Francisco, CA 94143.
    Affiliations
    Fetal Treatment Program, Department of Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Radiology, and Department of Pediatrics, University of California, San Francisco, San Francisco, California
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  • Klaus G. Schmidt
    Affiliations
    Fetal Treatment Program, Department of Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Radiology, and Department of Pediatrics, University of California, San Francisco, San Francisco, California
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  • Norman H. Silverman
    Affiliations
    Fetal Treatment Program, Department of Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Radiology, and Department of Pediatrics, University of California, San Francisco, San Francisco, California
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  • Robert L. Anderson
    Affiliations
    Fetal Treatment Program, Department of Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Radiology, and Department of Pediatrics, University of California, San Francisco, San Francisco, California
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  • James D. Goldberg
    Affiliations
    Fetal Treatment Program, Department of Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Radiology, and Department of Pediatrics, University of California, San Francisco, San Francisco, California
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  • Roy A. Filly
    Affiliations
    Fetal Treatment Program, Department of Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Radiology, and Department of Pediatrics, University of California, San Francisco, San Francisco, California
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  • Timothy M. Crombleholme
    Affiliations
    Fetal Treatment Program, Department of Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Radiology, and Department of Pediatrics, University of California, San Francisco, San Francisco, California
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  • Michael T. Longaker
    Affiliations
    Fetal Treatment Program, Department of Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Radiology, and Department of Pediatrics, University of California, San Francisco, San Francisco, California
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  • Mitchell S. Golbus
    Affiliations
    Fetal Treatment Program, Department of Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Department of Radiology, and Department of Pediatrics, University of California, San Francisco, San Francisco, California
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  • Author Footnotes
    * Supported by a fellowship from the Medical Research Council of Canada.
      This paper is only available as a PDF. To read, Please Download here.
      Most sacrococcygeal teratomas diagnosed before birth can be managed by planned delivery and postnatal surgery. However, large tumors early in gestation may result in placentomegaly, hydrops, and fetal death and a preeclampsia-like syndrome in the mother. This chain of events may result from high output cardiac failure in the fetus caused by arteriovenous shunting through the tumor. We recently encountered this situation in a fetus at 21 weeks' gestation and performed fetal surgery in an attempt to reverse the process. Excision of the teratoma resulted in reversal of hydrops, diminution of descending aortic flow on Doppler echocardiography, and decrease in placental thickness. Despite these changes, uterine irritability after hysterotomy resulted in labor and delivery of a nonviable premature infant. This case demonstrates that when fetal sacrococcygeal teratoma becomes very large early in gestation, high output cardiac failure can endanger both fetus and mother. In the future, use of Doppler echocardiography may allow appropriate selection of high-risk fetuses. Intervention to prevent arteriovenous shunting through the tumor may offer these fetuses an improved chance for survival. (Ann J OBSTET GYNECOL 1989;160:1145-50.) Key words: Sacrococcygeal teratoma, hydrops fetalis, high-output cardiac failure, fetal surgery, Doppler echocardiography
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