Fetal Cervical Teratoma as a Cause of Polyhydramnios

The production and removal of amniotic fluid has been the subject of much speculation and investigation. Excessive amounts of amniotic fluid occur in less than one-half of 1% of all pregnancies and the etiology is frequently unknown.1 Fetal malformations are associated with polyhydramnios in 20% to 40% of cases.1,2 In view of this, it is important for obstetricians and pediatricians to attempt to identify the presence of fetal anomalies through radiographic and sonographic investigation before delivery, as this information may modify obstetrics management, or facilitate pediatric and surgical care. An unusual cause of polyhydramnios is fetal cervical teratoma.3,4 The present case is reported to demonstrate that polyhydramnios can be investigated prenatally. Additionally, the diagnostic and therapeutic problems of cervical teratoma are reviewed. CASE REPORT A 25-year-old, Latin American woman, gravida 4, para 2, aborta 1, at 36 weeks of gestation was referred for the evaluation of polyhydramnios. The patient had noticed an increase in abdominal girth which had occurred rapidly over the two weeks before admission and led to a shortness of breath. On sonographic examination a marked excess in amniotic fluid was identified and the fetal biparietal diameter was 95 mm; fetal anomalies could not be detected. To relieve the mother's respiratory discomfort amniocentesis was done on two separate occasions and 3,800 ml of amniotic fluid was removed slowly. In order to evaluate fetal swallowing and gastrointestinal tract patency, 30 ml of 50% sodium-diatrizoate (Hypaque) were injected transabdominally into the amniotic sac. On a radiograph taken 12 hours later, the amniotic fluid was radiopaque, but no contrast material was identified in the fetal gastrointestinal tract.