Abnormal umbilical cord Doppler sonograms may predict impending demise in fetuses with sacrococcygeal teratoma. A report of two cases.
OBJECTIVE
To identify factors predictive of fetal demise in fetuses with sacrococcygeal teratoma (SCT).


METHODS
The recent management of monochorionic twins discordant for a large SCT and a singleton with a large SCT was reviewed.


RESULTS
Serial fetal echocardiography and ultrasonography with Doppler flow measurements documented rapid growth of the SCT in both cases with a relatively modest increase in combined cardiac output. No placentomegaly or hydrops was observed at any time. In both fetuses with SCT, evolution of abnormal umbilical artery waveforms was observed with the ultimate development of reversed end-diastolic umbilical arterial flow that was followed by sudden fetal demise.


CONCLUSIONS
Death in these 2 fetuses with large SCTs in the absence of placentomegaly/hydrops or hemodynamic changes suggestive of evolving high-output failure suggests a previously unrecognized mechanism of death in fetuses with large rapidly growing SCTs. In these cases, fetal demise may only be heralded by abnormal umbilical artery waveforms that progress to the premorbid observation of reversed diastolic umbilical artery blood flow. Umbilical artery waveform analysis should be closely monitored with other hemodynamic parameters in fetuses with large SCTs. In such fetuses, depending on the gestational age, abnormalities in umbilical artery waveform should be considered indications for early delivery or in utero intervention to prevent fetal demise.
Olutoye
Oluyinka O
OO
Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa. 19104, USA.
Johnson
Mark P
MP
Coleman
Beverly G
BG
Crombleholme
Timothy M
TM
Adzick
N Scott
NS
Flake
Alan W
AW
D000328:Adult; D003050:Coccyx; D017809:Fatal Outcome; D005260:Female; D005313:Fetal Death / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D012447:Sacrum; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging*; D013724:Teratoma / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014470:Umbilical Cord / Q000000981:diagnostic imaging*