Sacrococcygeal teratoma with hydrops fetalis and bilateral hydronephrosis

A 29-year-old Japanese primipara with fetal sacrococcygeal teratoma and hyd ronephrosis was referred to our department at 22 weeks of gestation. The pr eload index of the inferior vena cava (PLI) was 0.75 and fetal cardiac fail ure was suspected at 28 weeks of gestation. The sodium and chloride concent rations and osmolarity of the fetal urine were 96 mEq/L, 81 mEq/ L and 204 mOsm/L, respectively, and we predicted a good renal function. Then, a vesic o-amniotic shunting operation was performed at 28 weeks of gestation to kee p the renal function and PLI decreased 0.41 after this operation. At 30 wee ks of gestation, the fetus was delivered by a cesarean section owing to pre term FROM and a huge growing sacrococcygeal teratoma. The baby was female, weighing 2,020 g, and the 1 minute Apgar score was i. She died almost 7 hou rs after birth due to respiratory insufficiency. An autopsy confirmed bilat eral hydronephrosis, urethral stenosis, sacrococcygeal immature teratoma, a nd pulmonary hypoplasia. The size of this tumor revealed 80x 70 x 45 mm in intrapelvic cavity and 130 x 90 x 50 mm out of body, and this tumor was cla ssified as Type II according to the American Academy of Pediatrics Surgery Section classification.