Manejo perinatal del embarazo gemelar discordante para teratoma intrapericárdico: Comunicación de un caso y revisión de la literatura

Savino  Gil-Pugliese; Gabriela Cecilia  Taborda; Ignacio  Juaneda; Natalia  Tapia; Alina  Rizzotti; Florencia  Ducart; Betina  Vega; Luciana  Simes; Daiana  Ricart; Wilber  Estupiñan; Saulo  Molina-Giraldo; Alejandro  Peirone

doi:10.31403/rpgo.v70i2600

Authors

Savino Gil-Pugliese Programa de Medicina Fetal, Hospital Privado Universitario de Córdoba
Gabriela Cecilia Taborda Servicio de Ginecología y Obstetricia, Hospital Privado Universitario de Córdoba. Fundación Prenatal
Ignacio Juaneda Servicio de Cirugía de Cardiopatías Congénitas, Hospital Privado Universitario de Córdoba
Natalia Tapia Servicio de Neonatología, Hospital Privado Universitario de Córdoba
Alina Rizzotti Servicio de Neonatología, Hospital Privado Universitario de Córdoba
Florencia Ducart Servicio de Neonatología, Hospital Privado Universitario de Córdoba
Betina Vega Servicio de diagnóstico por imágenes, Clínica y Maternidad del Sol
Luciana Simes Servicio de Ginecología y Obstetricia, Hospital Privado Universitario de Córdoba
Daiana Ricart Fundación Prenatal
Wilber Estupiñan Universitaria de Ciencias de la Salud - FUCS; Departamento de Ginecología y Obstetricia Facultad de Medicina, Universidad Nacional de Colombia; Red de Terapia y Cirugía Fetal - FetoNetwork
Saulo Molina-Giraldo Servicio de Cardiología Pediátrica, Hospital Privado Universitario de Córdoba
Alejandro Peirone Universitaria de Ciencias de la Salud - FUCS; Departamento de Ginecología y Obstetricia Facultad de Medicina, Universidad Nacional de Colombia; Red de Terapia y Cirugía Fetal

DOI:

https://doi.org/10.31403/rpgo.v70i2600

Keywords:

Pregnancy, twin, Teratoma, Heart defects, congenital, Fetal therapies, Prenatal diagnosis, Pericardiocentesis

Abstract

This publication aims to provide an overview of the clinical course, treatment and
perinatal outcome of twin pregnancies discordant for intrapericardial teratoma.
Following PRISMA and Cochrane guidelines for systematic reviews, we selected all
publications that published on prenatally diagnosed twin pregnancies discordant
for intrapericardial teratoma. Seven publications were found, all of which were case
reports and were included in the final analysis, plus a recent case presented in this
publication. To date, 8 cases of twin pregnancies discordant for intrapericardial
teratoma have been reported. All (8/8) had severe pericardial effusion, 5 (62.5%)
developed hydrops and 2/8 (25%) polyhydramnios. Five (62.5%) cases were treated
with pericardiocentesis and 2 (25%) underwent concomitant amniodrainage because
of polyhydramnios. All cases were delivered by cesarean section with a median
gestational age of 34 weeks (RIC 32-35) and all were operated within the first three
days of life. In 7/8 cases (87.5%), the tumors originated in the ascending aorta. Both
twins survived in all cases. In conclusion, pericardiocentesis (+/- amniodrainage) of the
affected twin is the only fetal therapy reported to date in twin pregnancy discordant
for intrapericardial teratoma and the results are encouraging, although the evidence
is scarce. Prenatal treatment of twin pregnancies presenting with this pathology
should only be considered in the context of a highly trained multidisciplinary care
team.