**4.1 Prenatal management**

Fetal MRI is a powerful addition to the prenatal evaluation of fetuses with SCT. Due to the fact that, in most cases, neonatal surgery is required soon after cesarean section, the anatomic details of tumor extent and involvement of adjacent structures may affect the surgical approach. Patients with significant intrapelvic extension of the tumor may need a combined abdominoperineal approach to control the blood supply and achieve complete resection. All these may contribute to avoid resection-related complications during surgery [9] (**Figure 4**).

Monitoring for fetal distress during pregnancy is very important. Some large tumors have a very high blood flow that causes a shift in blood flow away, producing fetal hydrops. Other possible complications are bleeding inside the tumor, polyhydramnios and preterm labor. A rare condition is called "mirror syndrome" where the mother mirrors the baby's sickness, leading to fluid retention, preeclampsia, high blood pressure, heart failure [10, 11].
