Hepatic tumours account for 5% of all tumours in fetus and newborn and cause significant morbidity and mortality in the perinatal period. Timely diagnosis can help to plan the obstetric and neonatal management appropriately. We discuss clinical presentation, diagnosis and outcome in three cases over an 18 months period in which these women delivered in our unit and were associated with fetal liver tumours.
Case 1: Polyhydramnios and increased abdominal circumference due to fetal hepatomegaly were detected in scan at 33 weeks of gestation. After confirming the findings by an urgent MRI scan caesarean section was performed at 34 weeks of gestation. Postnatally baby was surgically treated for haemangioma of liver.
Case 2: Mother had raised AFP. Antenatal scans were unremarkable. After a routine induction and emergency caesarean for non reassuring CTG, at birth baby was noted to have a distended abdomen. Neonatal investigations confirmed a large vascular hepatic tumour.
Case 3: Abdominal distension was noted at birth after a normal vaginal delivery. Further investigations showed evidence of hepatoblastoma and is being treated.
Discussion Common hepatic tumours found are haemangiomas, mesenchymal tumours and hepatoblastomas. Antenatal diagnosis can be difficult due to complexity of tumours. Presence of heterogenous masses, thick septations, calcifications and abnormal vascular pattern should raise suspicion. Raised AFP, polyhydramnios, fetal hydrops, maternal mirror syndrome, CTG abnormalities and stillbirth are associated. Vascular /large tumours, are at risk of rupture or major haemorrhage during labour and caesarean section should be considered.
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