Perinatal management of twin pregnancy discordant for intrapericardial teratoma: A case report and literature review

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.