Kasus yang Langka: Sebuah Persalinan Normal dari Wanita Hamil Prematur dengan Janin Sacrococcygeal Teratoma

Cut Sheira Elnita, M. Adrianess Bachnas, Eric Edwin

Abstract


Latar belakang: Insiden kehamilan dengan janin Sacrococcygeal Teratoma (SCT) yaitu1 dari 35.000 kelahiran hidup. SCT dideteksi dengan skrining ultrasonografi (USG) prenatal trimester kedua.
Tujuan; Mendemonstrasikan peran USG janin dalam diagnosis SCT.
Laporan kasus: Wanita 20 tahun G2P1A0 kehamilan 28 minggu keluhan kontraksi, pecah selaput ketuban. Teraba janin tunggal, fundus teraba massa padat. Pemeriksaan genital pembukaan serviks 7 cm, USG intrauterin tunggal perkiraan usia kehamilan 28 minggu, tampak massa echogenic campuran dari daerah sacrococcygeal, terdapat daerah padat kistik di dalam massa ukuran 11,4 x 12,3 cm. Kemungkinan invasi ke panggul janin  disimpulkan SCT tipe II. Persalinan pervaginam, berat janin 1600 gram , apgar score 2-3-4, dengan massa padat kistik pada sacrum ukuran 13x13cm. Tampak perdarahan dari massa teratoma.
Hasil: SCT adalah neoplasma lesi kistik jinak. Komplikasi berupa perdarahan intramural masif dan distosia. Klasifikasi Altman: massa terdapat di eksterior atau intrapelvik, tipe I(47%): terletak di luar janin. tipe II(35%): massa terdapat di eksternal memiliki ekstensi intrapelvic. tipe III(8%): eksternal terletak di dalam panggul dan perut. tipe IV(10%): presakral tanpa presentasi eksternal. Pada USG, SCT muncul sebagai massa echogenisitas campuran yang memanjang dari sacrum. USG pada SCT padat (20%), kistik(30%) dan campuran(50%).
Kesimpulan: Ultrasonografi mempengaruhi keputusan dan manajemen klinis sehingga prognosis baik.

Kata kunci: Sacrococcygeal Teratoma, Kehamilan Prematur



Abstract
Background:  The incidence of pregnancy with fetal Sacrococcygeal Teratoma (SCT) occurs in 1 out of every 35.000 live births. SCT detected by second trimester prenatal ultrasonography (USG) screening.
Objective: Demonstrating the role of fetal ultrasound in the diagnosis of SCT.
Case report: a 20 year old G2P1A0 with 28 weeks pregnancy came with contractions and membranes ruptured. Examination found were single fetus, fundus palpable a mass. The cervical dilatation 7 cm, intrauterine ultrasound a 28 weeks of age fetus, appears an echogenic mass in the sacrococcygeal region containing a dense area 11.4x12.3 cm. We concluded an invasive to the fetal pelvis was type II SCT. Vaginal delivery performed, baby weight 1600 grams, apgar score 2-3-4, solid mass in sacrum 13x13cm. Bleeding from teratoma mass emerged.
Result: SCT is a rare tumour. Complications consist of massive bleeding and dystocia. SCT classified according to Altman. Type I(47%): located outside fetus, type II(35%): mass available on external with intrapelvic extension, type III(8%): externally located inside pelvis and abdomen, type IV(10%): presacral without external presentation. On ultrasound, SCT appears as a mixed echogenicity mass extending sacrum. Ultrasound: solid SCT(20%), cystic(30%) and mixed(50%).
Conclusion: Ultrasonography affects decisions and clinical management that make a good prognosis.

Key words: Sacrococcygeal Teratoma, Premature Pregnancy

Keywords


sacrococcygeal teratoma, premature pregnancy

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References


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DOI: http://dx.doi.org/10.24198/obgynia.v2n2s.137

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