Fetal sacrococcygeal teratoma: new about an old problem

Fetal sacrococcygeal teratoma (SCT) is a complex multifactorial disease; the prediction of its outcomes remains an unresolved problem. SCT complicates not only the postnatal period, but also the antenatal one: there is compression of adjacent organs, tumor rupture, tumor hemorrhage, heart failure, nonimmune hydrops fetalis (NIHF), and antepartum fetal death. A literature analysis could identify the factors of an adverse outcome in fetal SCT; when they are detected, fetal surgery is used worldwide. The goal of intrauterine surgery is to reduce/stop blood supply to the tumor and to resect or completely remove the latter in order to improve perinatal outcomes.

Early detection of fetal malformations, widespread clinical introduction and use of the known factors of an adverse outcome will be able to make a timely decision on the possibility and expediency of prolonging pregnancy; but in some cases to significantly affect perinatal outcomes while timely using fetal surgical interventions. Fetal surgery for high-risk SCT certainly improves perinatal outcomes; however, there is today no consensus on the indications for surgery, procedures, and timing of implementation, which requires further investigations.

Conclusion: When there is a preponderance of a cystic component having a low vascularity, the prognosis of SCT is considered relatively favorable. When there is solid SCT with an abundant vascularity, there are high risks for heart failure and NIHF, resulting in an adverse outcome. Therefore, these cases need active tactics: follow-up, intrauterine surgical interventions done as clinically indicated, as well as timely delivery.