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A challenging delivery by EXIT procedure of a fetus with a giant cervical teratoma
Nadine Johnson1, Prakesh S Shah2, Patrick Shannon3
1Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto ON.
Background:
Congenital giant neck teratomas are rare tumours associated with high perinatal mortality. Recent advances in prenatal diagnosis and delivery by ex utero intrapartum treatment (EXIT) have improved perinatal outcome.
Case:
An otherwise healthy 32-year-old woman, gravida 3, para 2, was referred to our institution at 25 weeks' gestation with a diagnosis of a fetal giant cervical teratoma. Ultrasound and magnetic resonance imaging (MRI) findings suggested airway obstruction in the fetus. An EXIT procedure was attempted but did not result in survival of the baby, despite extensive preoperative planning and the best efforts of a multidisciplinary team.
Conclusion:
Despite prenatal detection and diagnosis of airway compromise in a fetus with a giant neck teratoma, securing the fetal airway can be challenging. This is because massive teratomas can completely distort normal tissue and anatomy.
