Second-trimester diagnosis and multidisciplinary management of fetal sacrococcygeal teratoma: A case report with favorable perinatal outcome

Background: Sacrococcygeal teratomas (SCTs) are rare congenital tumors arising from totipotent germ cells, most located at the base of the coccyx. Although typically benign, their variable morphology, vascularity, and growth pattern may pose significant perinatal risks, including high-output cardiac failure, fetal hydrops, and dystocia. Early diagnosis and structured prenatal monitoring are critical for optimizing neonatal outcomes.

Case Presentation: We report the case of a 37-year-old primigravida in whom a mixed-type SCT was diagnosed at 22+2 weeks of gestation during routine anomaly scanning. Fetal MRI confirmed a predominantly exophytic, cystic-solid mass without spinal involvement. Serial ultrasounds showed progressive tumor growth (from 32 × 35 mm to 104 × 68 mm), yet Doppler indices and fetal biometry remained within normal limits. Invasive genetic testing (amniocentesis with array-CGH) revealed a normal female karyotype, and no additional anomalies were detected. Elective cesarean delivery was planned to minimize intrapartum complications. Postnatal surgical resection was completed successfully within 24 hours of life. Histology confirmed a mature teratoma, and postoperative recovery was uneventful.

Conclusion: This case underscores the importance of timely prenatal imaging, comprehensive genetic evaluation, and coordinated multidisciplinary care in the management of SCTs. Even in cases of rapid tumor growth, conservative prenatal management can lead to excellent neonatal outcomes when key risk factors are absent. The continuous involvement of specialized midwives—particularly in counseling and emotional support, complements the roles of physicians and surgeons, reinforcing the value of an integrated team-based approach to complex fetal conditions.