Fetal tumors associated with hydrops: The role of the pediatric surgeon

Fetal tumors are being diagnosed with increasing frequency and great accuracy by antenatal ultrasound. High-output cardiac failure and hydrops indicate fetal distress. Management may be limited by the gestational age of the fetus. Our experience with three fetal tumors demonstrates the dilemma with respect to timing of delivery and prognosis. Following the diagnosis of a large sacrococcygeal tumor, a 22-week-gestation fetus became hydropic and died. Another fetus with a rapidly growing posterolateral chest wall mass required cesarean section delivery at 29 weeks gestation. Postnatal course was complicated by pulmonary hypoplasia, intratumoral hemorrhage, and death. The third fetus had an enlarging tumor in the right lobe of the liver. Poor biophysical profile and mild hydrops necessitated cesarean section delivery at 34 weeks. Right hepatic lobectomy was performed and the infant was subsequently discharged home at one month of age. The deleterious effects of the fetal tumor and the need for its removal have to be carefully weighed against the ability of the fetus to survive postnatally.