Foetal sacrococcygeal teratoma: extremes in clinical presentation.

Sacrococcygeal teratoma (SCT) is a congenital tumour that can be diagnosed by ultrasonography (USG). We present our experience with the management of two cases of SCT in our institution between 2008 and 2009. In the first case, SCT was diagnosed at 17 weeks' gestation. The patient was followed up with fortnightly USG to monitor the tumour size, foetal growth and signs of foetal hydrops. The patient delivered a baby girl by Caesarean section at 37 weeks, with good Apgar scores. The neonate underwent an uneventful resection of SCT on Day 1 of life. In the second case, SCT was diagnosed at 20 weeks during screening. In view of foetal hydrops and anaemia, the patient underwent three in utero foetal blood transfusions. A baby boy was delivered by Caesarean section at 28 weeks. There was a large friable SCT with massive haemorrhage. Despite maximal resuscitative efforts, the neonate died 30 minutes after birth.

The use of anti-D immunoglobulins for rhesus prophylaxis: audit on knowledge and practices among obstetricians.

INTRODUCTION: The development of anti-D antibodies results from foetomaternal sensitisation occurring in rhesus (Rh) negative blood group women who carry an Rh-positive foetus. Despite guidelines on Rh immunoprophylaxis, isoimmunisation continues to occur, suggesting that the guidelines are not being fully applied by obstetricians. This study aims to establish the adequacy of knowledge on Rh immunoprophylaxis among obstetricians and trainees in obstetrics and gynaecology in Singapore, and their usual practice in the care of an Rh-negative mother; and hence to audit their practice in accordance with evidence-based guidelines. METHODS: An anonymous questionnaire survey auditing obstetricians' knowledge of guidelines on anti-D prophylaxis and their usual practice in the clinical setting. RESULTS: The mean score achieved on the questionnaire was 75.9 percent. Many obstetricians did not know that anti-D immunoglobulins (Ig) should be given within 72 hours of a sensitising event for successful immunoprophylaxis. In clinical practice, all the obstetricians who participated in the questionnaire would offer anti-D Ig prophylaxis to Rh-negative women both antenatally and postnatally. However, only 12.7 percent of them would routinely perform a Kleihauer test in Rh-negative women following delivery. CONCLUSION: The knowledge on anti-D prophylaxis among obstetricians can be improved. A continual system of education to raise awareness of evidence-based practices as well as clinical audit has been implemented to address this.