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Muraoka J, Yoshimoto N, Ohsawa A, Matsuzawa S, Katsuragi S. Fetal Distress and Neonatal Death After Thoracoamniotic Shunting Therapy Due to Hydrops Associated With Transient Abnormal Myelopoiesis. Cureus 2022; 14:e28991. [PMID: 36225415 PMCID: PMC9541969 DOI: 10.7759/cureus.28991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
We present the case of a pregnant woman who developed fetal bradycardia, which required an emergency cesarean delivery immediately after thoracoamniotic shunting (TAS), resulting in neonatal death four hours after birth due to hemodynamic deterioration. A 35-year-old Japanese female was referred to our hospital at 30+0 weeks of gestation due to fetal hydrops. Blood and ultrasonography examinations suggested that transient abnormal myelopoiesis (TAM) due to trisomy 21 could contribute to the development of hydrops fetalis. We performed thoracocentesis and TAS replacement as well as chromosomal testing of the amniotic fluid. However, the fetus developed persistent bradycardia soon after the treatment, and a sonographic examination revealed a recurrence of fluid retention in the thoracic cavity. A 1,558-g male neonate received life-saving resuscitation after being born via emergency surgery. Blood analysis revealed the occurrence of TAM in utero. At autopsy, there were no injuries to the intrathoracic organs. The G-banded karyotype revealed trisomy 21 (47, XY, +21). Our case offers new perspectives on providing prenatal information about potential complications to family members and selecting fetuses for TAS in the case of trisomy 21 complicated with TAM.
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Takita H, Matsuoka R, Goto M, Tokunaka M, Arakaki T, Nakamura M, Sekizawa A. Long-term outcome of cases of fetal pleural effusion: A study at a single perinatal center in Japan. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:805-809. [PMID: 35394680 DOI: 10.1002/jcu.23196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To analyze the long-term prognosis of primary and secondary fetal pleural effusion (FPE). METHODS We investigated all cases of FPE in a single University hospital (2005-2020). Cases were classified as primary (cases with only pleural effusion) and secondary (cases with other abnormalities such as chromosomal abnormalities or fetal cardiac failure). We retrospectively reviewed the medical records from the time of diagnosis, to assess medical procedures performed, chromosomal test results, and clinical outcomes. RESULTS Among 18 027 deliveries, 17 FPEs were identified (primary FPE: 8, secondary FPE: 9). Most primary FPEs were diagnosed in the second trimester of pregnancy, while all secondary FPEs were diagnosed in the third trimester. Secondary FPE was often associated with chromosomal abnormalities, including trisomy 21. The prognosis of pleural effusion caused by trisomy 21 was relatively good, except for cases with TAM. Cases of secondary FPE without trisomy 21 were of cardiac origin, and the neonatal prognosis was poor. The short-term prognosis was better in the primary FPE group, but long-term follow-up identified conditions such as acute encephalitis with refractory, repetitive partial seizures, developmental delay and attention deficit hyperactivity disorder. CONCLUSION Fetal pleural effusion without the presence of chromosomal abnormalities or morphologies has a good short-term prognosis, but the long-term prognosis is poor. Thus, long-term follow-up is necessary for all cases of fetal pleural effusion.
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Affiliation(s)
- Hiroko Takita
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Ryu Matsuoka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Minako Goto
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Mayumi Tokunaka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
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Grandt J, Gottschalk I, Geipel A, Gembruch U, Simonini C, Weber E, Berg C, Müller A, Strizek B. Intrauterine Thoracoamniotic Shunting of Fetal Hydrothorax with the Somatex Intrauterine Shunt: Intrauterine Course and Postnatal Outcome. J Clin Med 2022; 11:jcm11092312. [PMID: 35566436 PMCID: PMC9100171 DOI: 10.3390/jcm11092312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/10/2022] [Accepted: 04/19/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Severe fetal hydrothorax can be treated by intrauterine thoracoamniotic shunting (TAS). The aim of this study was to assess perinatal outcome and complication rates of TAS with a novel Somatex intrauterine shunt. (2) Methods: This is a single-center retrospective study of all fetuses with hydrothorax treated with TAS using a Somatex shunt between 2014 and 2020. (3) Results: A total of 39 fetuses were included in the study. Mean gestational age at first intervention was 27.4 weeks (range 19–33). Of these, 51% (n = 20) of fetuses had fetal hydrops, which resolved in 65% (13/20) before delivery. The live birth rate was 97% (n = 38), and 74% (n = 29) survived the neonatal period. The rate of postnatal pulmonary complications was high, with 88% of neonates requiring any kind of ventilatory support. There were 23% (n = 9) genetic abnormalities (trisomy 21 and Noonan syndrome). (4) Conclusions: TAS with a Somatex shunt has a high technical success rate, leading to high neonatal survival rates. Pregnancy and neonatal outcome is comparable to TAS for fetal hydrothorax using different shunt types.
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Affiliation(s)
- Joleen Grandt
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (J.G.); (A.G.); (U.G.); (C.S.); (C.B.)
| | - Ingo Gottschalk
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50923 Cologne, Germany; (I.G.); (E.W.)
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (J.G.); (A.G.); (U.G.); (C.S.); (C.B.)
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (J.G.); (A.G.); (U.G.); (C.S.); (C.B.)
| | - Corinna Simonini
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (J.G.); (A.G.); (U.G.); (C.S.); (C.B.)
| | - Eva Weber
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50923 Cologne, Germany; (I.G.); (E.W.)
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (J.G.); (A.G.); (U.G.); (C.S.); (C.B.)
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50923 Cologne, Germany; (I.G.); (E.W.)
| | - Andreas Müller
- Department of Neonatology and Pediatric Intensive Care, Children’s University Hospital Bonn, 53127 Bonn, Germany;
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (J.G.); (A.G.); (U.G.); (C.S.); (C.B.)
- Correspondence: ; Tel.: +49-228-287-37115
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Gámez-Varela A, Martínez-Rodríguez M, López-Briones H, Chávez-González E, Villalobos-Gómez R, Cruz-Martínez R. Are pregnancies with severe fetal hydrothorax and very short cervix candidates for pleuroamniotic shunting? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:783-784. [PMID: 33998074 DOI: 10.1002/uog.23686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/27/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Affiliation(s)
- A Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
| | - M Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
- Fetal Medicine Foundation of Mexico, Querétaro, Mexico
| | - H López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
| | - E Chávez-González
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
| | - R Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
| | - R Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
- Fetal Medicine Foundation of Mexico, Querétaro, Mexico
- Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico
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Gámez-Varela A, Martínez-Rodríguez M, López-Briones H, Luna-García J, Chávez-González E, Villalobos-Gómez R, Hernandez-Andrade E, Cruz-Martínez R. Preoperative Cervical Length Predicts the Risk of Delivery within One Week after Pleuroamniotic Shunt in Fetuses with Severe Hydrothorax. Fetal Diagn Ther 2021; 48:297-303. [PMID: 33784701 DOI: 10.1159/000514912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/31/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to assess the predictive performance of preoperative cervical length (CL) for delivery within 1 week after pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax. METHODS A prospective cohort of fetuses with severe hydrothorax referred to our fetal surgery center in Querétaro, Mexico from January 2012 to July 2020. Severe fetal hydrothorax was diagnosed as an accumulation of fluid within the fetal pleural space accompanied with severe bilateral lung compression, mediastinal shift, polyhydramnios, and/or hydrops. Transvaginal CL was measured immediately before PAS, and a short cervix was defined as that <25 mm. The interval from fetal intervention to delivery, prevalence of preterm prelabor rupture of membranes (PPROMs), and associations with delivery within the first week after PAS according to a short or a normal CL, were evaluated. RESULTS Thirty-five pregnancies with severe fetal hydrothorax treated with PAS were evaluated. Median gestational age at PAS was (weeks + days) 31+2 (range, 26+0-36+1). Two (5.7%) and 7 (20.0%) cases delivered within the first 24 h and 1 week after PAS, respectively. Ten (28.6%) women had a short cervix before PAS, while 25 (71.4%) had normal preoperative CL. Women with a short cervix showed lower mean interval between fetal intervention and delivery (2.4 vs. 5.5 weeks, p = 0.01), and higher prevalence of PPROM (50 vs. 12%, p = 0.01), as compared to women with a nonshort cervix. Preoperative short cervix was associated with significantly higher risk of delivery within the first 24 h (20.0 vs. 0%, respectively, p < 0.05) and 1 week after PAS (50.0 vs. 8.0%, respectively, p < 0.01) compared with pregnancies with normal preoperative CL. CONCLUSION In pregnancies with severe fetal hydrothorax candidates for pleuroamniotic shunt, identification of a short cervix before fetal intervention can predict delivery within 1 week after the surgical procedure.
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Affiliation(s)
- Alma Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico
| | - Miguel Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara,", Querétaro, Mexico
| | - Hugo López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico
| | - Jonahtan Luna-García
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico
| | | | - Rosa Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico
| | - Edgar Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Rogelio Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico.,Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara,", Querétaro, Mexico
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Abstract
Diagnosis and management of congenital lung malformations has evolved dramatically over the past several decades. Advancement in imaging technology has enabled earlier, more definitive diagnoses and, consequently, more timely intervention in utero or after birth, when indicated. These advancements have increased overall survival rates to around 95% from historical rates of 60%. However, further refinement of diagnostic technique and standardization of treatment is needed, particularly as the increased sensitivity of diagnostic imaging results in more frequent diagnoses. In this article, we provide an updated review of the diagnostic strategies, management, and prognosis of congenital lung malformations.
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Affiliation(s)
- Michael Zobel
- Fetal Treatment Center, Department of Surgery, University of California, San Francisco
| | - Rebecca Gologorsky
- Fetal Treatment Center, Department of Surgery, University of California, San Francisco
| | - Hanmin Lee
- Fetal Treatment Center, Department of Surgery, University of California, San Francisco
| | - Lan Vu
- Fetal Treatment Center, Department of Surgery, University of California, San Francisco.
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Nørgaard LN, Søgaard K, Jensen LN, Ekelund C, Kahrs BH, Tabor A, Sundberg K. New intrauterine shunt for treatment of fetal fluid accumulation: single-center experience of first 17 cases. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:418-420. [PMID: 29700877 DOI: 10.1002/uog.19074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/06/2018] [Accepted: 04/11/2018] [Indexed: 06/08/2023]
Affiliation(s)
- L N Nørgaard
- Center of Fetal Medicine, Department of Obstetrics and Gynaecology, Copenhagen University Hospital Rigshospitalet, Copenhagan, Denmark
| | - K Søgaard
- Center of Fetal Medicine, Department of Obstetrics and Gynaecology, Copenhagen University Hospital Rigshospitalet, Copenhagan, Denmark
| | - L N Jensen
- Center of Fetal Medicine, Department of Obstetrics and Gynaecology, Copenhagen University Hospital Rigshospitalet, Copenhagan, Denmark
| | - C Ekelund
- Center of Fetal Medicine, Department of Obstetrics and Gynaecology, Copenhagen University Hospital Rigshospitalet, Copenhagan, Denmark
| | - B H Kahrs
- National Center for Fetal Medicine, Trondheim University Hospital, Trondheim, Norway
| | - A Tabor
- Center of Fetal Medicine, Department of Obstetrics and Gynaecology, Copenhagen University Hospital Rigshospitalet, Copenhagan, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - K Sundberg
- Center of Fetal Medicine, Department of Obstetrics and Gynaecology, Copenhagen University Hospital Rigshospitalet, Copenhagan, Denmark
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Abbasi N, Ryan G. Fetal primary pleural effusions: Prenatal diagnosis and management. Best Pract Res Clin Obstet Gynaecol 2019; 58:66-77. [PMID: 30737016 DOI: 10.1016/j.bpobgyn.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
Fetal pleural effusions can be associated with significant perinatal morbidity and mortality. When diagnosed antenatally, referral to a tertiary fetal medicine center is recommended for a detailed ultrasound evaluation for additional structural abnormalities or features suggestive of congenital infections or fetal anemia. The effusions should be characterized as unilateral or bilateral, and presence of hydrops and/or mediastinal shift should be documented. Additional testing should include fetal echocardiography, maternal testing for blood group and screen, hemoglobinopathies, and congenital infections. Invasive genetic testing is recommended with infectious testing on amniotic or pleural fluid. Pleuroamniotic shunting is recommended for large primary pleural effusions with significant mediastinal shift or hydrops, as several large series have demonstrated improvement in perinatal survival, particularly in hydropic fetuses. Delivery should occur in a tertiary care center with neonatal expertise, and infants should be followed up long-term for respiratory and neurodevelopmental outcomes.
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Affiliation(s)
- Nimrah Abbasi
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Canada.
| | - Greg Ryan
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Canada.
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Thoracoamniotic shunting for fetal pleural effusion with hydropic change using a double-basket catheter: An insight into the preoperative determinants of shunting efficacy. Eur J Obstet Gynecol Reprod Biol 2018; 221:34-39. [DOI: 10.1016/j.ejogrb.2017.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/20/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022]
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10
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Riley JS, Urwin JW, Oliver ER, Coleman BG, Khalek N, Moldenhauer JS, Spinner SS, Hedrick HL, Adzick NS, Peranteau WH. Prenatal growth characteristics and pre/postnatal management of bronchopulmonary sequestrations. J Pediatr Surg 2018; 53:265-269. [PMID: 29229484 PMCID: PMC5828905 DOI: 10.1016/j.jpedsurg.2017.11.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 11/08/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The prenatal natural history of intralobar and extralobar bronchopulmonary sequestrations (BPSs), including lesion growth patterns and need for prenatal intervention, have not been fully characterized. We review our series of BPSs to determine their natural history and outcomes in the context of the need for prenatal intervention. METHODS A retrospective review of the pre/postnatal course of 103 fetuses with an intralobar (n=44) or extralobar BPS (n=59) managed at a single institution between 2008 and 2015 was performed. Outcomes included prenatal lesion growth trajectory, presence of hydrops, need for prenatal intervention, survival, and postnatal surgical management. RESULTS Most extralobar (71%) and intralobar BPSs (94%) decreased in size or became isoechoic from initial to final evaluation. Peak lesion size occurred at 26-28weeks gestation. Eight fetuses developed hydrothorax, four of which (all extralobar BPSs) also developed hydrops. All four hydropic fetuses received maternal betamethasone, and three hydropic fetuses underwent thoracentesis and/or thoracoamniotic shunt placement with subsequent hydrops resolution. All fetuses survived. Forty-one intralobar (93%) and 35 extralobar BPSs (59%) were resected after birth. CONCLUSIONS BPSs tend to decrease in size after 26-28weeks gestation and rarely require fetal intervention. Lesions resulting in hydrothorax ± hydrops can be effectively managed with maternal steroids and/or drainage of the hydrothorax. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- John S Riley
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John W Urwin
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Edward R Oliver
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Beverly G Coleman
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nahla Khalek
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie S Moldenhauer
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan S Spinner
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Holly L Hedrick
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N Scott Adzick
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William H Peranteau
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Yumoto Y, Jwa SC, Wada S, Takahashi Y, Ishii K, Kato K, Usui N, Sago H. The outcomes and prognostic factors of fetal hydrothorax associated with trisomy 21. Prenat Diagn 2017; 37:686-692. [DOI: 10.1002/pd.5066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/28/2017] [Accepted: 05/06/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Yasuo Yumoto
- Department of Obstetrics and Gynecology, Kyushu University Hospital; Kyushu University; Fukuoka Japan
| | - Seung Chik Jwa
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine; National Center for Child Health and Development; Tokyo Japan
| | - Seiji Wada
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine; National Center for Child Health and Development; Tokyo Japan
| | - Yuichiro Takahashi
- Department of Fetal-Maternal Medicine; Nagara Medical Center; Gifu Japan
| | - Keisuke Ishii
- Maternal Fetal Medicine; Osaka Women's and Children's Hospital; Izumi Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Kyushu University Hospital; Kyushu University; Fukuoka Japan
| | - Noriaki Usui
- Department of Pediatric Surgery; Osaka Women's and Children's Hospital; Izumi Japan
| | - Haruhiko Sago
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine; National Center for Child Health and Development; Tokyo Japan
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12
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Wada S, Jwa SC, Yumoto Y, Takahashi Y, Ishii K, Usui N, Sago H. The prognostic factors and outcomes of primary fetal hydrothorax with the effects of fetal intervention. Prenat Diagn 2017; 37:184-192. [DOI: 10.1002/pd.4989] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/24/2016] [Accepted: 12/09/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Seiji Wada
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine; National Center for Child Health and Development; Tokyo Japan
| | - Seung Chik Jwa
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine; National Center for Child Health and Development; Tokyo Japan
| | - Yasuo Yumoto
- Department of Obstetrics and Gynecology; Kyushu University Hospital, Kyushu University; Fukuoka Japan
| | - Yuichiro Takahashi
- Department of Fetal-Maternal Medicine; Nagara Medical Center; Gifu Japan
| | - Keisuke Ishii
- Department of Maternal Fetal Medicine; Osaka Medical Center and Research Institute for Maternal and Child Health; Izumi Japan
| | - Noriaki Usui
- Department of Pediatric Surgery; Osaka Medical Center and Research Institute for Maternal and Child Health; Izumi Japan
| | - Haruhiko Sago
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine; National Center for Child Health and Development; Tokyo Japan
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13
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Hellmund A, Berg C, Geipel A, Bludau M, Heydweiller A, Bachour H, Müller A, Müller A, Gembruch U. Prenatal Diagnosis and Evaluation of Sonographic Predictors for Intervention and Adverse Outcome in Congenital Pulmonary Airway Malformation. PLoS One 2016; 11:e0150474. [PMID: 26978067 PMCID: PMC4792474 DOI: 10.1371/journal.pone.0150474] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 02/14/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To describe antenatal findings and evaluate prenatal risk parameters for adverse outcome or need for intervention in fetuses with congenital pulmonary airway malformation (CPAM). METHODS In our retrospective study all fetuses with a prenatal diagnosis of CPAM detected in our tertiary referral center between 2002 and 2013 were analyzed. Sonographic findings were noted and measurements of mass-to-thorax-ratio (MTR), congenital pulmonary airway malformation volume-ratio (CVR) and observed to expected lung-to head-ratio (o/e LHR) were conducted and correlated to fetal or neonatal morbidity and mortality and/or need for prenatal intervention. RESULTS 67 fetuses with CPAM were included in the study. Hydropic fetuses were observed in 16.4% (11/67) of cases, prenatal intervention was undertaken in 9 cases; 7 pregnancies were terminated. The survival rate of non-hydropic fetuses with conservatively managed CPAM was 98.0% (50/51), the survival rate for hydropic fetuses with intention to treat was 42.9% (3/7). 10 (18.2%) children needed respiratory assistance. Fetuses with a CVR of <0.91 were significantly less likely to experience adverse outcome or need for prenatal intervention with sensitivity, specificity and positive/negative predictive value of 0.89, 0.71, 0.62 and 0.93, respectively. A MTR (mass-to-thorax-ratio) of < 0.51 had a positive predictive value of 0.54 and a negative predictive value of 0.96 of adverse events with a sensitivity of 0.95 and a specificity of 0.63. The negative predictive value for o/e LHR of 45% was 0.84 with sensitivity, specificity and positive predictive value of 0.73, 0.68 and 0.52, respectively. CONCLUSIONS The majority of cases with CPAM have a favorable outcome. MTR and CVR are able to identify fetuses at risk, the o/e LHR is less sensitive.
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Affiliation(s)
- Astrid Hellmund
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
- * E-mail:
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
- Division of Prenatal Medicine and Gynecologic Sonography, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Meike Bludau
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | | | - Haitham Bachour
- Division of Pediatric Surgery, University of Bonn, Bonn, Germany
| | - Andreas Müller
- Department of Neonatology, University of Bonn, Bonn, Germany
| | - Annette Müller
- Department of Pathology, University of Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
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14
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Jeong BD, Won HS, Lee MY, Shim JY, Lee PR, Kim A. Perinatal outcomes of fetal pleural effusion following thoracoamniotic shunting. Prenat Diagn 2015; 35:1365-70. [DOI: 10.1002/pd.4709] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Ba-Da Jeong
- Department of Obstetrics and Gynecology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Mi-Young Lee
- Department of Obstetrics and Gynecology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Jae-Yoon Shim
- Department of Obstetrics and Gynecology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Pil-Ryang Lee
- Department of Obstetrics and Gynecology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Ahm Kim
- Department of Obstetrics and Gynecology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
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15
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Peranteau WH, Adzick NS, Boelig MM, Flake AW, Hedrick HL, Howell LJ, Moldenhauer JS, Khalek N, Martinez-Poyer J, Johnson MP. Thoracoamniotic shunts for the management of fetal lung lesions and pleural effusions: a single-institution review and predictors of survival in 75 cases. J Pediatr Surg 2015; 50:301-5. [PMID: 25638624 DOI: 10.1016/j.jpedsurg.2014.11.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Hydrops and pulmonary hypoplasia are associated with significant morbidity and mortality in the setting of a congenital lung lesion or pleural effusion (PE). We reviewed our experience using in utero thoracoamniotic shunts (TA) to manage fetuses with these diagnoses. METHODS A retrospective review of fetuses diagnosed with a congenital lung lesion or pleural effusion who underwent TA shunt placement from 1998-2013 was performed. RESULTS Ninety-seven shunts were placed in 75 fetuses. Average gestational age (±SD) at shunt placement and birth was 25±3 and 34±5 weeks. Shunt placement resulted in a 55±21% decrease in macrocystic lung lesion volume and complete or partial drainage of the PE in 29% and 71% of fetuses. 69% of fetuses presented with hydrops, which resolved following shunt placement in 83%. Survival was 68%, which correlated with GA at birth, % reduction in lesion size, unilateral pleural effusions, and hydrops resolution. Surviving infants had prolonged NICU courses and often required either surgical resection or tube thoracostomy in the perinatal period. CONCLUSION TA shunts provide a therapeutic option for select fetuses with large macrocystic lung lesions or PEs at risk for hydrops and/or pulmonary hypoplasia. Survival following shunting depends on GA at birth, reduction in mass size, and hydrops resolution.
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Affiliation(s)
- William H Peranteau
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - N Scott Adzick
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthew M Boelig
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alan W Flake
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Holly L Hedrick
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lori J Howell
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Julie S Moldenhauer
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Nahla Khalek
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Juan Martinez-Poyer
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mark P Johnson
- The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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16
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Reiterer F, Grossauer K, Morris N, Uhrig S, Resch B. Congenital pulmonary lymphangiectasis. Paediatr Respir Rev 2014; 15:275-80. [PMID: 24997116 DOI: 10.1016/j.prrv.2014.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 05/09/2014] [Indexed: 12/31/2022]
Abstract
Congenital pulmonary lymphangiectasis (CPL) is a rare vascular malformation causing dilated lymph vessels and disturbed drainage of lymph fluid. Based on the pathogenesis and clinical phenotype it can be classified as primary or secondary CPL. Associated genetic syndromes with or without lymphedema, familial occurrence and gene mutations have been described. In utero, it may present as non-immune hydrops with pleural effusions. At birth neonates may have respiratory failure due to chylothorax and pulmonary hypoplasia, causing very high short term mortality rates. Other cases may become symptomatic any time later in childhood or even during adult life. CPL is usually diagnosed based on the combination of clinical signs, imaging and histological findings. Open-lung biopsy is considered the gold standard for the diagnosis of CPL. Treatment is primarily supportive featuring aggressive mechanical ventilation and the management of problems associated with congenital chylothorax including chest-drainage, medium-chain triglycerides (MCT) diet, and octreotide.
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Affiliation(s)
- Friedrich Reiterer
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Austria.
| | - Karin Grossauer
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Austria
| | - Nicholas Morris
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Austria
| | - Sabine Uhrig
- Institute of Human Genetics, Medical University of Graz, Austria
| | - Bernhard Resch
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Austria
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