title: Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas.
abstract: BACKGROUND
  Large, prenatally diagnosed sacrococcygeal teratomas (SCTs) present a formidable challenge because of their unpredictable growth and propensity for complications. In our experience, even with aggressive serial imaging, many fetuses have died under a policy of "watchful waiting." We propose "early delivery" as the best option for selected cases of high-risk fetal SCT.
  
  
  METHODS
  The medical charts of all fetuses with SCT followed up at our institution and delivered before 32 weeks of gestation were reviewed for radiologic findings, fetal interventions, delivery information, perinatal inpatient course, and autopsy or discharge report.
  
  
  RESULTS
  Between 1996 and 2009, excluding those that underwent fetal surgery, 9 patients with fetal SCT were delivered before 32 weeks of gestation. Four had type I tumors, and 5 had type II tumors. Of the 9 fetuses, 4 survived the neonatal period. The only surviving patient delivered before 28 weeks underwent an ex utero intrapartum therapy procedure.
  
  
  CONCLUSIONS
  A significant number of pregnancies complicated by high-risk SCT will manifest signs of fetal or maternal decompensation, or both, between 27 and 32 weeks of gestation. In the absence of fulminant hydrops, preemptive early delivery can be associated with surprisingly good outcomes in appropriately selected fetuses with high-risk SCT.
authors.affiliation: The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, PA, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Roybal
authors.forename: Julie S
authors.initials: JS
authors.lastname: Moldenhauer
authors.forename: Nahla
authors.initials: N
authors.lastname: Khalek
authors.forename: Michael W
authors.initials: MW
authors.lastname: Bebbington
authors.forename: Mark P
authors.initials: MP
authors.lastname: Johnson
authors.forename: Holly L
authors.initials: HL
authors.lastname: Hedrick
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
mesh_terms: D016534:Cardiac Output, High / Q000196:embryology / Q000209:etiology; D002585:Cesarean Section; D002658:Developmental Disabilities / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D046128:Fetal Therapies; D005865:Gestational Age; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D015160:Hydrops Fetalis / Q000209:etiology / Q000517:prevention & control; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D007752:Obstetric Labor, Premature; D010386:Pelvic Neoplasms / Q000151:congenital / Q000196:embryology / Q000601:surgery; D011225:Pre-Eclampsia / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D012189:Retrospective Studies; D012445:Sacrococcygeal Region; D013724:Teratoma / Q000151:congenital / Q000196:embryology / Q000601:surgery*; D016216:Ultrasonography, Prenatal