P28.12: Intrauterine spontaneus rupture of a sacrococcygeal teratoma diagnosed by amniocentesis

Abstract

Sacrococcygeal teratoma (SCT) is a rare fetal neoplasm, which contains the three germinal layers, with an incidence of 1 in 40,000 births. It is usually diagnosed by ultrasound in early second trimester. Fetus prognosis is mainly determined by the following factors: polyhydramnios, high-output cardiac failure, hydrops, urinary tract or bowel obstruction, preterm labor, tumor rupture and dystocia. We report a case of a fetus with SCT that suffered a spontaneus rupture. Patient was reffered after her second trimestre morphologic ultrasound with 24 weeks gestation. The ultrasound and the MRI showed a large solid-cytic mass in the fetus sacral region with intrabdominal extension and bilateral hydronephrosis. At 29 weeks the patient developed an important polyhydramnios and was submitted to an amnioreduction. During the procedure a brownish amniotic fluid was observed and a hypothesis of a previous spontaneus rupture of the SCT was suspected. An ultrasound screening, with Doppler, was weekly performed looking for signs of fetal anemia but no others abnormalities were found and pregnancy continued until 32 weeks gestation when she was admitted in preterm labor and a cesarean section was performed. Female neonate was born weighting 2170 g and with Apgar scores 4 and 8. The neonatal evaluation showed signs of previous rupture of SCT and there was no active bleeding or neonatal anemia. The newborn was submitted to a surgical ressection of the tumor but, unfortunately, the neonate died two weeks later due to late surgical complications. Very few cases of intrauterine spontaneus rupture of SCT were found in literature. This complication increases the morbi-mortality of these fetuses because of the acute bleeding and anemia. Recognition of this possibility and efforts to make early diagnostis can determine a better outcome.