Introduction: Fetal intrapericardial teratoma is a rare tumor that can be diagnosed by antenatal ultrasonography early in pregnancy. Case Presentation: A fetal intrapericardial teratoma was detected on routine ultrasonography in the second trimester of pregnancy. At 31 weeks gestation, a marked increase in tumor size, fetal ascites, and pericardial effusion were observed, indicating that preterm delivery would be inevitable. Corticosteroid prophylaxis (24 mg of betamethasone in two doses of 12 mg 24 h apart) initiated for prophylaxis of respiratory distress syndrome led to a reduction in fetal ascites and pericardial effusion. Betamethasone therapy (4 mg/per day) was continued with the aim to postpone the expected date of delivery. Gestation was extended for more than 2 weeks. At 33 weeks and 5 days gestation, the neonate was delivered by elective cesarean section with ex utero intrapartum treatment and immediately submitted to fetal cardiac surgery. The infant was discharged from the hospital in good health about 4 months later. Conclusion: The present report draws attention to improvement in fetal status and extension of gestation achieved with maternal low-dose corticosteroid therapy on antenatal ultrasound finding of fetal ascites and pericardial effusion due to intrapericardial teratoma.

1.
Bonasoni
MP
,
Comitini
G
,
Barbieri
V
,
Palicelli
A
,
Salfi
N
,
Pilu
G
.
Fetal presentation of mediastinal immature teratoma: ultrasound, autopsy and cytogenetic findings
.
Diagnostics
.
2021
;
11
:
1543
9
.
2.
Heerema-McKenney
A
,
Harrison
MR
,
Bratton
B
,
Farrell
J
,
Zaloudek
C
.
Congenital teratoma: a clinicopathologic study of 22 fetal and neonatal tumors
.
Am J Surg Pathol
.
2005
;
29
(
1
):
29
38
.
3.
Arvind
A
,
Rajeshkumar
R
,
Thakur
D
,
Sridhar
A
,
Sivaprakasm
MC
.
Successful management of a neonate with antenatally detected mature intrapericardial teratoma
.
Ann Pediatr Cardiol
.
2019
;
12
(
2
):
182
4
.
4.
Rychik
J
,
Khalek
N
,
Gaynor
JW
,
Johnson
MP
,
Adzick
NS
,
Flake
AW
.
Fetal intrapericardial teratoma: natural history and management including successful in utero surgery
.
Am J Obstet Gynecol
.
2016
215
6
780.e1
7
.
5.
Isaacs
H
.
Fetal and neonatal cardiac tumors
.
Pediatr Cardiol
.
2004
;
25
(
3
):
252
73
.
6.
Fagiana
AM
,
Barnett
S
,
Reddy
VS
,
Milhoan
KA
.
Management of a fetal intrapericardial teratoma: a case report and review of the literature
.
Congenit Heart Dis
.
2010
;
5
(
1
):
51
5
.
7.
Nassr
AA
,
Shazly
SA
,
Morris
SA
,
Ayres
N
,
Espinoza
J
,
Erfani
H
.
Prenatal management of fetal intrapericardial teratoma: a systematic review
.
Prenat Diagn
.
2017
;
37
(
9
):
849
63
.
8.
Viora
E
,
Sciarrone
A
,
Muccinellf
E
Test di screening prenatale dei difetti congeniti
Aogoi
2017
.
9.
Stock
S
,
Thomson
A
,
Papworth
S
Royal College of Obstetricians and Gynaecologists
.
Antenatal corticosteroids to reduce neonatal morbidity and mortality: green-top Guideline No. 74
.
BJOG
.
2022
;
129
(
8
):
e35
60
.
10.
Marwan
A
,
Crombleholme
TM
.
The EXIT procedure: principles, pitfalls, and progress
.
Semin Pediatr Surg
.
2006
;
15
(
2
):
107
15
.
11.
Watterberg
KL
,
Aucott
S
,
Benitz
WE
,
Cummings
JJ
,
Eichenwald
EC
,
Goldsmith
J
.
The apgar score
.
Pediatrics
.
2015
;
136
(
4
):
819
22
.
12.
Gobbi
D
,
Rubino
M
,
Chiandetti
L
,
Zanon
GF
,
Cecchetto
G
.
Neonatal intrapericardial teratoma: a challenge for the pediatric surgeon
.
J Pediatr Surg
.
2007
42
1
E3
6
.
13.
Gaetani
M
,
Damiani
GR
,
Pellegrino
A
,
Rizzo
N
,
Martelli
F
,
Aly
Y
.
Diagnosis and management of a rare case of fetal mediastinal teratoma without non-immunological hydrops
.
J Obstet Gynaecol
.
2016
;
36
(
3
):
390
2
.
14.
Takayasu
H
,
Kitano
Y
,
Kuroda
T
,
Morikawa
N
,
Tanaka
H
,
Fujino
A
.
Successful management of a large fetal mediastinal teratoma complicated by hydrops fetalis
.
J Pediatr Surg
.
2010
;
45
(
12
):
e21
4
.
15.
Upadhyaya
M
,
Jaffar Sajwany
M
,
Tomas-Smigura
E
.
Recurrent immature mediastinal teratoma with life-threatening respiratory distress in a neonate
.
Eur J Pediatr Surg
.
2003
;
13
(
6
):
403
6
.
16.
Miller
SL
,
Chai
M
,
Loose
J
,
Castillo-Meléndez
M
,
Walker
DW
,
Jenkin
G
.
The effects of maternal betamethasone administration on the intrauterine growth-restricted fetus
.
Endocrinology
.
2007
;
148
(
3
):
1288
95
.
17.
Society for Maternal-Fetal Medicine SMFM
Norton
ME
,
Chauhan
SP
,
Dashe
JS
.
Society for maternal-fetal medicine (SMFM) clinical guideline #7: nonimmune hydrops fetalis
.
Am J Obstet Gynecol
.
2015
;
212
(
2
):
127
39
.
18.
Prasetyono
TOH
,
Djoenaedi
I
.
Efficacy of intralesional steroid injection in head and neck hemangioma: a systematic review
.
Ann Plast Surg
.
2011
;
66
(
1
):
98
106
.
19.
Guenot
C
,
Dubrit
K
,
Lepigeon
K
,
Giannoni
E
,
Baud
D
,
Vial
Y
.
Effect of maternal betamethasone on hydrops fetalis caused by extralobar pulmonary sequestration: a case report
.
J Obstet Gynaecol
.
2019
;
39
(
1
):
120
2
.
20.
Peranteau
WH
,
Wilson
RD
,
Liechty
KW
,
Johnson
MP
,
Bebbington
MW
,
Hedrick
HL
.
Effect of maternal betamethasone administration on prenatal congenital cystic adenomatoid malformation growth and fetal survival
.
Fetal Diagn Ther
.
2007
;
22
(
5
):
365
71
.
21.
Pock
R
,
Straňák
Z
,
Vojtěch
J
,
Hašlík
L
,
Feyereisl
J
,
Krofta
L
.
Bronchopulmonary sequestration with fetal hydrops in a monochorionic twin successfully treated with multiple courses of betamethasone
.
AJP Rep
.
2018
8
4
E359
61
.
22.
Nozaki
AM
,
Francisco
RPV
,
Fonseca
ESVB
,
Miyadahira
S
,
Zugaib
M
.
Fetal hemodynamic changes following maternal betamethasone administration in pregnancies with fetal growth restriction and absent end-diastolic flow in the umbilical artery
.
Acta Obstet Gynecol Scand
.
2009
;
88
(
3
):
350
4
.
23.
Antolic
A
,
Wood
CE
,
Keller-Wood
M
.
Chronic maternal hypercortisolemia in late gestation alters fetal cardiac function at birth
.
Am J Physiol Regul Integr Comp Physiol
.
2018
314
3
R342
52
.
24.
Agnew
EJ
,
Ivy
JR
,
Stock
SJ
,
Chapman
KE
.
Glucocorticoids, antenatal corticosteroid therapy and fetal heart maturation
.
J Mol Endocrinol
.
2018
61
1
R61
73
.
25.
Asztalos
EV
,
Murphy
KE
,
Willan
AR
,
Matthews
SG
,
Ohlsson
A
,
Saigal
S
.
Multiple courses of antenatal corticosteroids for preterm Birth study outcomes in children at 5 years of age (MACS-5)
.
JAMA Pediatr
.
2013
;
167
(
12
):
1102
10
.
26.
Shanks
AL
,
Grasch
JL
,
Quinney
SK
,
Haas
DM
.
Controversies in antenatal corticosteroids
.
Semin Fetal Neonatal Med
.
2019
;
24
(
3
):
182
8
.
27.
Vesce
F
,
Giugliano
E
,
Cagnazzo
E
,
Mossuto
E
,
Marci
R
.
Low dose of betamethasone throughout the whole course of pregnancy and fetal growth: a clinical study
.
Eur Rev Med Pharmacol Sci
.
2014
;
18
(
4
):
593
8
.
28.
Huhta
JC
,
Paul
JJ
.
Doppler in fetal heart failure
.
Clin Obstet Gynecol
.
2010
;
53
(
4
):
915
29
.
29.
Srisupundit
K
,
Luewan
S
,
Tongsong
T
.
Prenatal diagnosis of fetal heart failure
.
Diagnostics
.
2023
;
13
(
4
):
779
.
You do not currently have access to this content.