Prenatal percutaneous needle drainage of cystic sacrococcygeal teratomas

Prenatal ultrasound (US) permits in utero diagnosis of sacrococcygeal terat oma (SCT), follow-up of tumor size,and the early identification of complica tions, allowing for a more timely and appropriate delivery. The recommended management of large SCTs is delivery by cesarean section (CS) to prevent d ystocia, tumor rupture, hemorrhage, and death. However, even delivery by CS can be difficult, necessitating a large hysterotomy that adds to maternal morbidity. The authors report two cases of cystic SCTs in which prenatal pe rcutaneous drainage allowed for an uncomplicated vaginal delivery. In the f irst case, a large unilocular cystic SCT was diagnosed at 31 weeks' gestati on on prenatal US. The fetal presentation was breech, and the mass was stea dily increasing in size, preventing spontaneous version. At 375/7 weeks, th e cyst was percutaneously drained under US guidance allowing for successful external version. Repeat drainage just before induction of labor permitted a successful vaginal delivery. In the second case, the cystic SCT was perc utaneously drained just before induction of labor at full term, again allow ing for an uncomplicated vaginal delivery Prenatal percutaneous needle drai nage of cystic SCTs offers an alternative to CS that results in decreased r isks for both mother and fetus. J Pediatr Surg 34:1148-1151. Copyright (C) 1999 by W.B. Saunders Company.