*Prenatal Diagnosis and Management of Sacrococcygeal Teratomas DOI: http://dx.doi.org/10.5772/intechopen.87987*

malignancy in SCT is increasing with age. Failure to remove the coccyx results in 30–40% recurrence rate, with a higher probability of malignancy. Alpha fetoprotein may be used to detect early occurrence of malignancy.

Management of SCT depends on fetal lung maturation and presence of placental enlargement and/or fetal hydrops. When maturity of fetal lung without placental enlargement and/or hydrops fetalis, planned cesarean section is indicated. Some authors recommend preventive early delivery by cesarean section when the tumor exceeds the diameter of 5 cm, to avoid complications such as rupture and hemorrhage. The primary treatment of SCT is early surgical resection with complete excision of the coccyx. Early surgical intervention is associated with better prognosis. The surgical approach depends on the degree of pelvic extension. Posterior sacral approach is recommended in type I and II, and combined abdominal and posterior sacral approaches in type III and IV. The technique of wide resection of benign lesions with coccygectomy is helpful in preventing recurrence and has changed little over the last four decades.

The goals of surgical resection of an SCT are:


*Basic Principles and Practice in Surgery*

high blood pressure, heart failure [10, 11].

**4.2 Surgical management**

any urinary or bowel dysfunction.

to tumor spillage or incomplete excision.

*Antenatal diagnosis of SCT using MRI and measurements.*

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

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,

Most fetal teratomas could be managed by planned delivery and postnatal surgery. The earlier the diagnosis and surgical intervention, the better the prognosis. A complete surgical excision of the tumor including coccygectomy is necessary, in order to avoid recurrence. A long term observation and follow-up is required for

Mature teratomas should not recur, if complete surgical excision and coccygectomy were achieved properly. Recurrence is reported in literature, as 2–35%, in patients with immature teratomas operated after the age of 5 months and is related

At the time of birth, most lesions are benign and surgical resection can be accomplished with relatively low morbidity and mortality. The incidence of

to avoid resection-related complications during surgery [9] (**Figure 4**).

**4. Management**

**4.1 Prenatal management**

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**Figure 4.**


After inserting a urinary catheter, the patient is placed in the prone jack-knife position. A V-shaped incision is made at the superior margin of the tumor. It is important to identify the course of the anus by placing a tube in the anal canal. After raising skin flaps, the muscles are dissected from the tumor which must be resected with the coccyx, after ligation of its main blood supply, which are middle sacral artery or branches from the hypogastric arteries [4, 7, 12].
