Diagnosis and management of fetal sacrococcygeal teratoma.

Four cases of fetal sacrococcygeal teratomas were managed in Kuwait Maternity Hospital in the previous 2.5 years, making an incidence of 1 in 10,000 deliveries. Three were diagnosed antenatally and one unbooked case presented during labor with dystocia. Polyhydramnios and characteristic ultrasonic tumor echogenicity were documented. Two patients were delivered vaginally after partial excision of the tumor through hysterotomy. In all cases female infants were delivered. Tumor size dictated the mode of delivery being vaginal in cases with maximum tumor diameter less than 10 cm. A single infant survived after tumor excision done 48 h after delivery. All tumors were histopathologically benign. Routine antenatal ultrasonic examinations should allow early diagnosis of such cases to avoid unanticipated dystocia. In the absence of associated major anomalies amniocentesis may relieve maternal symptoms, when necessary, and postpone onset of premature labor, vaginal delivery should be allowed in cases with maximal tumor diameter less than 10 cm. This should be conducted in a center with experienced neonatal and pediatric surgical care.