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2019-10-27  Sacrococcygeal teratoma  © Imane Benchiba  www.TheFetus.net

Sacrococcygeal teratoma
Imane BenchibaNessiba Abdelkader , Nissrine Mamouni , Sanaa Errarhay, Chahrazed Bouchikhi , Abdelaziz Banani

Obstetrics and Gynecology I - HASSAN II University Hospital – Fez- Morocco

Introduction
Sacrococcygeal teratoma a common and benign fetal tumor. Yet, fetuses with sacrococcygeal tumors that are predominantly solid and highly vascularized have a high risk of hydrops and tumor hemorrhage, associated with a higher risk of fetal death. They develop at the expense of totipotent embryonic cells in the sacrococcygeal region and are usually benign during the antenatal period. However, their removal must be performed during the first year of life to avoid degeneration. The hyper vascularized forms are the most serious and may benefit in some cases from in utero surgical or endoscopic management. The management of delivery depends on associated anomalies, tumor vascularity and size.

Case report
A 34-year-old woman, G4P3, 3 vaginal deliveries, had a level III ultrasound at 29 weeks, which revealed normal fetal biometry, a slight increase in amniotic fluid, and a large mass in the sacrococcygeal region.
The patient was scheduled for caesarean section; unfortunately, a vaginal delivery was performed at the time of transfer.
  
   
Discussion
The objective of the prenatal diagnosis of these tumors is twofold: to issue a fetal prognosis according to the type, the size and the composition of the tumor, and to evaluate the risk of complications by the tumor growth and extension.
Although usually an isolated malformation. not part of a polymalformative syndrome, associated malformations may be present in 5 to 26% of cases depending on the series. MRI analyzes more precisely than ultrasound the tumor extension
Antenatal surveillance: Ultrasound is used to assesses the size and especially the tumoral growth and the associationd with an increased risk of fetal cardiac decompensation
In utero fetal therapeutics: only in the presence of major complications. These different treatments aim to reduce tumor vasculature in utero
Fetal surgery to "open uterus"; this invasive approach consists of a maternal laparotomy with hysterotomy that provides access to the fetus with a high risk of premature rupture of the membranes and premature delivery
Endoscopic Fetal Surgery: The advantage of this endoscopic therapeutic approach is to limit uterine trauma and maintain the fetus in its natural environment.
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