Use of External Cephalic Version and Amnioreduction in the Delivery of a Fetal Demise with Macrocephaly Secondary to Massive Intracranial Teratoma

Abstract

Introduction Congenital intracranial tumors are rare and often incidentally diagnosed on routine ultrasound. We report a case of a fetal demise with a massive intracranial teratoma at 25 weeks of gestation and the management of her delivery in the setting of macrocephaly, breech presentation, and polyhydramnios.

Case A 31-year-old G3P1011 woman at 25 weeks' gestation presented with a recent fetal demise and a fetal intracranial tumor first identified at 16 weeks' gestational age. The patient had declined termination of pregnancy. Biometry was consistent with 24 weeks' gestation, except for a head circumference of 394.4 mm consistent with 39 weeks' gestation. The fetus was in a breech presentation. An external cephalic version (ECV) was successfully performed under epidural anesthesia and an amnioreduction was then performed to stabilize the fetal position. Immediate induction of labor and vaginal delivery followed.

Discussion ECV and amnioreduction may help facilitate delivery in cases of fetal demise complicated by macrocephaly, malpresentation, and polyhydramnios.

Keywords

fetal brain tumor - intracranial teratoma - prenatal diagnosis - external cephalic version - amnioreduction

• References

• 1 Manoranjan B, Provias JP. Congenital brain tumors: diagnostic pitfalls and therapeutic interventions. J Child Neurol 2011; 26 (5) 599-614
• 2 Chien YH, Tsao PN, Lee WT, Peng SF, Yau KI. Congenital intracranial teratoma. Pediatr Neurol 2000; 22 (1) 72-74
• 3 Koizumi K, Abe E, Kusanagi Y, Ito M. Giant immature intracranial teratoma with antenatal cranial perforation. J Obstet Gynaecol Res 2010; 36 (6) 1252-1255
• 4 Saada J, Enza-Razavi F, Delahaye S, Martinovic J, Macaleese J, Benachi A. Early second-trimester diagnosis of intracranial teratoma. Ultrasound Obstet Gynecol 2009; 33 (1) 109-111
• 5 Goffinet F, Carayol M, Foidart JM , et al; PREMODA Study Group. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol 2006; 194 (4) 1002-1011
• 6 Chasen ST, Chervenak FA, McCullough LB. The role of cephalocentesis in modern obstetrics. Am J Obstet Gynecol 2001; 185 (3) 734-736
• 7 Dickinson JE, Tjioe YY, Jude E, Kirk D, Franke M, Nathan E. Amnioreduction in the management of polyhydramnios complicating singleton pregnancies. Am J Obstet Gynecol 2014; 211 (4) 434.e1-434.e7