Sonographic prognostic factors in fetuses with sacrococcygeal teratoma

Background: A subset of fetuses with sacrococcygeal teratoma (SCT) develops hydrops caused by high-output heart failure. Identification of fetuses at risk for hydrops is important because fetal intervention may reverse the pa thophysiology of the disease. To date, no reliable sonographic prognostic f actors have been identified. Methods: An experienced sonologist reviewed the sonographic records of 17 f etuses with SCT referred to the authors' institution. Size of the tumor was measured and corrected for fetal size. The appearance of the tumor (solid versus cystic) and its vascularity were graded on a subjective scale of 1 t o 5. Results: Only 4 of 12 fetuses that had hydrops survived; of the survivors, 3 had undergone fetal intervention. All nonhydropic fetuses survived. Fetus es with hydrops had tumors that were mainly solid and highly vascular, wher eas nonhydropic fetuses had predominantly cystic tumors with comparatively less vascularity There was no significant difference in tumor size between these 2 groups. Conclusions: Fetuses with SCT that are mainly solid in appearance and are h ighly vascularized have a higher risk of getting hydrops in utero, Tumor si ze is not an independent prognostic factor. J Pediatr Surg 35:322-326. Copy right (C) 2000 by W.B. Saunders Company.