Abstract
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.
References
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, et al. 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, et al. 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, et al. 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, et al. 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, et al. 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, et al. 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, et al. 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, et al. 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.
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