Summary of Medical Study

Article Title: "Sonographic Prognostic Factors in Fetuses with Sacrococcygeal Teratoma (Westerburg et al, 35 J. of Ped. Surg. pp. 322-326 Feb. 2000)"

The aim of this study by a group working out of Univ. of Cal. at San Francisco was to attempt to identify sonographic factors associated with the development of fetal hydrops and an unfavorable pregnancy outcome. The authors reviewed the histories of 17 fetal SCT cases presented at UCSF from 1986 to 1998.

There were no significant differences in tumor size or ratio of tumor size to fetal head or abdomen circumference between fetuses that had hydrops (n=12) and those that did not have hydrops (n=5). The group of hydropic fetuses, however, differed significantly in the following three (3) categories: tumor vascularity; tumor morphology (shape); and presence of intrapelvic extension of the tumor. Fetuses with hydrops had tumors that were vascular, solid, and extended into the pelvic region. Non-hydropic fetuses, however, had tumors that were predominantly cystic, minimally vascular, and largely external.

Of the 12 hydropic fetuses, only 4 survived. 3 of the 4 developed hydrops prior to viability and underwent open fetal surgical intervention. The fourth surviving hydropic fetus developed hydrops at 32 weeks and was immediately delivered by c-section.

The most common obstetric indication for sonography in this setting is fundal height greater than expected for the gestational age. The abnormal fundal height is caused by tumor mass or associated polyhydramnios (excessive amniotic fluid).

The size of the tumor is not a predictor of outcome in the case of fetal SCTs. More important than tumor size in predicting outcome is the relative vascularity of the tumor along with the degree of intrapelvic extension. Basically, the more vascular the tumor and the greater the degree of an internal component, the worse the prognosis.


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