Antenatal and Postnatal Management of Sacrococcygeal Teratoma

Sacrococcygeal teratoma (SCT) is the most common congenital germ cell tumor and is often detected antenatally. Advances in routine obstetric ultrasonography now allow for earlier risk stratification and identification of tumors that may precipitate potentially lethal conditions such as high-output cardiac failure, nonimmune hydrops, and maternal mirror syndrome. Antenatal risk assessment integrates tumor morphology, growth kinetics, and fetal cardiovascular status to determine the optimal management strategy for both the fetus and the pregnant patient. Surgical management relies on multidisciplinary perinatal planning and includes complete oncologic resection with coccygectomy. Incomplete resection, tumor spillage, failure to remove the coccyx, and immature/malignant tumor elements are the primary drivers of recurrence. Survival is generally favorable for resectable tumors, but long-term surveillance is important in order to monitor for recurrence and bladder and/or bowel dysfunction. Surveillance with serial clinical examination, alpha-fetoprotein monitoring, and cross-sectional imaging is effective in identifying early recurrence. This review synthesizes the epidemiology, pathogenesis, antenatal and postnatal management, outcomes, and postoperative surveillance for SCTs.