Fetal Neck Masses

A fetal neck mass is an abnormal growth in the neck that affects babies before they are born. In severe cases, the neck mass can block a baby’s airway or esophagus, causing breathing problems at birth or preventing a baby’s ability to swallow. Obstruction of the esophagus in particular may also lead to the build-up of amniotic fluid in the womb (polyhydramnios), which can then cause preterm labor.

At the SSM Health Cardinal Glennon St. Louis Fetal Care Institute, we understand the anxiety and worry you may have about a fetal neck mass diagnosis. Our doctors are specially trained to help you and your baby, providing the advanced monitoring and treatment plan you need to relieve your anxiety and have a healthy baby.

In most cases, a neck mass can be managed after your pregnancy and delivery. However, when a neck mass obstructs the breathing airway or esophagus, we will consider a variety of interventions to ensure you and your baby’s well-being.

What Causes Fetal Neck Mass?

Fetal neck masses are rare and usually there is no genetic cause. The most common type of fetal neck mass - cystic hygroma (also known as a cervical lymphatic malformation or lymphangioma) - is caused by an abnormality in the development of the lymphatic channels in the neck. A cervical teratoma - another, rarer, kind of neck mass - is usually caused when reproductive cells become abnormally located in the neck and begin to grow.

How is a Fetal Neck Mass Diagnosed and Evaluated?

A fetal neck mass is typically detected by an ultrasound around 20 weeks gestation. When you are referred to the Cardinal Glennon St. Louis Fetal Care Institute with a fetal neck mass diagnoses, our team of specialists will perform an in-depth evaluation to determine the size and impact of the mass on your baby. This evaluation includes:

  • Frequent ultrasounds
  • A fetal echocardiogram: ultrasound of the heart performed by a pediatric cardiologist
  • A fetal MRI to determine the nature and size of the mass, as well as how it is impacting the airway, esophagus and other surrounding organs

We will also conduct a complete physical exam, genetic evaluation, and review of your history to rule out any other complications you may be experiencing with your pregnancy.

How Are Neck Masses Managed?

Throughout your pregnancy, our goal is to monitor the neck mass and determine if it’s growing, and how it may impact your baby. If the mass is compromising the airway or esophagus or is causing an increase in amniotic fluid, fetal intervention may be necessary.

Currently, there is not a prenatal surgery option for fetal neck masses. However, we are able to remove excess fluid through procedure called amnioreduction. This procedure involves local anesthetic and a needle which is inserted into the womb to drain the fluid.

How Will a Fetal Neck Mass Impact Delivery?

In most cases, babies with a small neck mass can be delivered vaginally with a low risk of complications. After you go home, we follow you as an outpatient for two to four weeks. During this time, we’ll refer your baby to a pediatric surgeon who will determine if and when your baby requires a surgery to remove the mass.

EXIT Procedure

In severe cases, a large neck mass can prevent a baby from breathing at birth. If this happens, an EXIT (Ex Utero Intrapartum Treatment) procedure may be performed for your delivery.  During EXIT, you will give birth by C-section while asleep under general anesthesia. This will allow the surgeon to evaluate and treat your baby’s airway while your baby’s placenta and umbilical cord remain attached.

If your baby is having difficulty breathing because the lungs are not fully developed, ECMO (Extracorporeal Membrane Oxygenation) is used to give your baby’s lungs more time to grow. Once your baby is breathing well, the umbilical cord is cut and your baby is fully delivered.

What Can I Expect After My Baby is Born With a Fetal Neck Mass?

If the neck mass compresses your baby’s airway, your baby may need a tracheostomy (a surgical opening in the trachea, often called a breathing tube) to make breathing easier. A temporary feeding tube to help provide nutrition may also be necessary if your baby is unable to swallow at birth.

After your baby is stabilized, the treatment of choice for a neck mass is surgery. In nearly all cases, babies who receive surgery for a neck mass go on to develop normally without problems. However, it will be important for your child to receive ongoing follow-up care as they will have a higher chance of mass re-growth.

We understand that a neck mass can be a scary diagnosis. That’s why we’re available to help 24 hours a day, 7 days a week. For more information or to schedule an appointment, call us at 314-268-4037 or toll free at 877-SSM-FETL (877-776-3385). You can also email us and one of our trusted representatives will get back to you as soon as possible.

Throughout your journey, our team is here to provide you the expert care and support your need, helping you and your baby get the most out of treatment and life.

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