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Clinical Monitoring of Sacrococcygeal Teratoma.
- Source :
-
Fetal diagnosis and therapy [Fetal Diagn Ther] 2019; Vol. 46 (5), pp. 333-340. Date of Electronic Publication: 2019 Mar 20. - Publication Year :
- 2019
-
Abstract
- Background: Sacrococcygeal teratomas (SCT) are often highly vascularized and may result in high-output cardiac failure, polyhydramnios, fetal hydrops, and demise. Delivery is guided by the SCT to fetus volume ratio (SCTratio), SCT growth rate, and cardiac output indexed for weight (CCOi).<br />Methods: We compared measurements and outcome in 12 consecutive fetuses referred with SCT. Adverse outcomes were: fetal surgery, delivery < 32 gestational weeks or neonatal demise. Only SCTratio and CCOi were used to manage the cases. SCT vascularization index (VI%) was derived from the 3D virtual organ computer-aided analysis (VOCAL) software. The SCTModel (modified from acardiac twins) calculated a hypothetical SCT draining vein size and derived a risk line, using diameters of the superior and inferior vena cava, the azygous and umbilical veins. VI% and a model of systemic and umbilical venous volumes (SCTModel) were tested as indicators for outcome in SCT.<br />Results: Fetuses were monitored from 20.1 to 36.4 gestational weeks and 5/12 had adverse outcomes: 1 had successful open fetal surgery at 23.8 weeks and delivered at term, 4 delivered at < 32 weeks with 3/4 having neonatal demise between 25 and 29 weeks. VI% was significantly higher in cases with adverse outcomes (mean 10.3 [8.9-11.6] vs. 4.4 [3.4-5.3], p < 0.0001). The additional fraction of the fetal cardiac output required to perfuse the SCT-draining vein (XSCO%) (p = 0.46), SCTratio (p = 0.08), and CCOi (p = 0.64) were not significant. All cases with adverse outcome had VI% > 8%. The SCTModel risk line predicted nonadverse outcomes well but lacked data in 2/5 cases with adverse outcomes.<br />Conclusions: VI% is a significant indicator of SCT cases with adverse outcomes and combined with SCTratio may guide timing of delivery better than current measures.<br /> (© 2019 S. Karger AG, Basel.)
- Subjects :
- Clinical Decision-Making
Female
Fetal Death
Fetal Therapies
Gestational Age
Humans
Models, Cardiovascular
Patient Selection
Predictive Value of Tests
Pregnancy
Premature Birth mortality
Regional Blood Flow
Reproducibility of Results
Risk Assessment
Risk Factors
Sacrococcygeal Region
Spinal Neoplasms mortality
Spinal Neoplasms surgery
Teratoma mortality
Teratoma surgery
Term Birth
Treatment Outcome
Decision Support Techniques
Fetal Monitoring methods
Spinal Neoplasms blood supply
Spinal Neoplasms diagnostic imaging
Teratoma blood supply
Teratoma diagnostic imaging
Ultrasonography, Doppler
Ultrasonography, Prenatal
Subjects
Details
- Language :
- English
- ISSN :
- 1421-9964
- Volume :
- 46
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Fetal diagnosis and therapy
- Publication Type :
- Academic Journal
- Accession number :
- 30893693
- Full Text :
- https://doi.org/10.1159/000496841