Introduction: Sacrococcygeal teratoma (SCT) occurs commonly in neonates and infants and poses significant obstetric and fetal challenges, especially in resource-strained settings. SCT affects 1 in every 35,000–40,000 live births. Prompt diagnosis and effective management of SCT improve obstetric and neonatal outcomes. Case presentation: A 25-year-old gravida 2 para 1+0 at 27 weeks gestation was admitted to the hospital with complaints of intermittent lower abdominal pain and reduced fetal movements. Physical examination revealed bilateral pitting oedema up to the knees and a fundal height of 38 weeks, suggesting a large-for-gestational-age (LGA) fetus. Obstetric ultrasonography showed a single live fetus in cephalic presentation with a sacrococcygeal mass measuring 11.44 × 9.87 × 12.70 cm and mild polyhydramnios. Biochemical investigations were normal. After stabilisation and counselling, the patient was referred to a tertiary facility for advanced obstetric, oncology and surgical management. Clinical discussion: SCT arises from totipotent germ cells and is classified by histology and anatomy. Antenatal ultrasound is the primary diagnostic tool, although CT/MRI is superior in defining tumor extent. Complications such as fetal hydrops and obstructive effects are common. Complete surgical excision remains the definitive treatment, with the prognosis depending on tumor size, malignancy, and recurrence risk. Resource limitations impede timely interventions in such settings. Conclusion: This case demonstrates the critical role of antenatal diagnosis and prompt referral in managing SCT. Multidisciplinary coordination and early intervention can improve outcomes, even in resource-constrained environments.
