Clinical Monitoring of Sacrococcygeal Teratoma

Christoph Wohlmuth, Eric Bergh, Cynthia Bell, Anthony Johnson, Kenneth J. Moise, Martin J.C. Van Gemert, Jeroen P.H.M. Van Den Wijngaard, Iris Wohlmuth-Wieser, Ian Averiss, Helena M. Gardiner

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


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). 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. 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. 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.

Original languageEnglish
Pages (from-to)333-340
Number of pages8
JournalFetal Diagnosis and Therapy
Issue number5
StatePublished - 1 Nov 2019


  • Cardiovascular pathophysiology
  • Fetal surgery
  • Hydrops
  • Sacrococcygeal teratoma
  • Umbilical/venous diameter ratio
  • Vascularization index


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