Spectrum of intrapartum management strategies for giant fetal cervical teratoma.
OBJECTIVE
The management of the fetus with a large neck mass that obstructs the airway remains a clinical challenge. The authors review their experience with giant fetal cervical teratoma and discuss options for management.


METHODS
A retrospective review of all patients referred since 1994 for prenatal management of a fetal neck mass was performed. Variables examined included gestational age at diagnosis and delivery, size and location of the neck mass, presence of fetal hydrops, associated anomalies, management methods, operating time, and outcome.


RESULTS
Seven patients were identified with a prenatal diagnosis of giant cervical teratoma. Four patients had fetal hydrops; of these, 2 died in utero of hydrops, and a third fetus underwent elective termination. The remaining hydropic and previable fetus underwent fetal surgery for resection of the mass. The 3 nonhydropic patients underwent ex utero intrapartum treatment (EXIT) procedures for airway control. Endotracheal intubation was possible in one patient, and one received a tracheostomy. In the third fetus, neither intubation nor tracheostomy were possible, and resection of the neck mass was performed on placental support. There were no deaths in the surgical group.


CONCLUSIONS
The management of fetal giant cervical teratoma includes a spectrum of options. For the rare previable fetus with hydrops, fetal resection may be indicated. In patients with airway obstruction, EXIT procedure provides the luxury of time to obtain airway control either by intubation, tracheostomy, or, if necessary, tumor resection on placental support.
Hirose
Shinjiro
S
Department of Surgery, University of California, San Francisco, California 94143-0570, USA.
Sydorak
Roman M
RM
Tsao
Kuojen
K
Cauldwell
Charles B
CB
Newman
Kurt D
KD
Mychaliska
George B
GB
Albanese
Craig T
CT
Lee
Hanmin
H
Farmer
Diana L
DL
D000025:Abortion, Eugenic; D000328:Adult; D000402:Airway Obstruction / Q000209:etiology / Q000517:prevention & control; D000465:Algorithms; D019090:Case Management; D002585:Cesarean Section; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005333:Fetus / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000150:complications / Q000196:embryology / Q000601:surgery*; D006801:Humans; D015160:Hydrops Fetalis / Q000209:etiology; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D011247:Pregnancy; D012189:Retrospective Studies; D013724:Teratoma / Q000150:complications / Q000196:embryology / Q000601:surgery*; D014139:Tracheostomy; D016896:Treatment Outcome