Background: Sacrococcygeal teratoma is one of the most frequently prenatally diagnosed neoplasias. Obstetric ultrasound has a role in the diagnosis and management of these tumors during pregnancy. In this report, we describe a multidisciplinary approach in a case of a patient with sacrococcygeal teratomas and preterm delivery, as well as postnatal outcomes. Case presentation: A 26-year-old Caucasian woman at 20.3 weeks of gestation with a normal gestational course and no relevant medical or surgical history was referred to our institution with a sacrococcygeal mass diagnosis. Magnetic resonance imaging confirmed the diagnosis of sacrococcygeal teratoma type I according to the Altman classification. Follow-up with ultrasound showed an increase in the size of the mass up to 190 × 150 mm, high Doppler flow, and severe polyhydramnios. At 35.1 weeks of gestation, the patient had premature rupture of membranes, and an emergency cesarean section was performed due to recurrent late decelerations detected by fetal heart rate monitoring. Afterward, surgery was performed successfully at 36 hours of life. Posterior controls revealed normal and healthy child growth. Conclusions: This case report demonstrates the importance of a multidisciplinary approach to offer the best neonatal outcomes by performing early surgery, as well as the need for follow-up by ultrasound in order to minimize complications by assessing mass growth, Doppler flow, and amniotic fluid.

Objectives: Usefulness on exploration of intracavity pathologies and their impact on fertility.

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Methods: This was a retrospective cohort study at the gynecological ultrasound unit of a tertiary hospital, which included primipara women who performed a pelvic floor ultrasound (US) between January 2012 and January 2020. LAM avulsion was sought by 3D transperineally US, using tomographic imaging of the puborectalis portion of LAM, on the plane of minimal hiatal dimensions. A levator-uretra gap >25mm identified minor or major avulsion. Age, parity, type of delivery, newborn weight, clinical symptoms and history of pelvic surgery were assessed by clinical records. Results: A total of 224 women were included, with median age of 59 (24-90) years. Pelvic prolapse (25,9%) and stress urinary incontinence (18,3%) were the most frequent signs/symptoms. Most women (62%) had an eutocic delivery, followed by forceps (21,4%), Caesarean (11,6%) and vacuum (4,9%) extraction. Avulsion of LAM was detected in 42,8%, however this rate was significantly more frequent with forceps (83,3%), followed by eutocic (36,7%)/vacuum extraction (36,4%) and less frequent in Caesarean section, where this event was almost absent (3,8%; p < 0,001). Globally, the most frequent type of lesion was bilateral major avulsion (13,8%), followed by unilateral major (11,2%) and bilateral minor avulsion (7,1%). A subjective impression of a thinner puborectalis portion was noted in 16% of non-avulsion cases. Unilateral lesions were mainly on right sided of the body (68% vs 32%, p < 0,001). At multivariate logistic regression, age and type of delivery appear independently associated to LAM avulsion (p = 0,026). Conclusions: Our results suggest that, in primipara women, a positive association exists between forceps and LAM avulsion, while Caesarean appears to be protective. The most frequent type of lesion is bilateral major avulsion and right sided unilateral lesions are more frequent than left ones. VP68.11 Diagnostic accuracy of 3D transperineal ultrasound for detecting obstetrical anal sphincter injuries: a systematic review and meta-analysis