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Weber M, Monier I, Rahshenas M, Salomon LJ, Sananes N, Castaigne V, Houfflin-Debarge V, Jouannic JM, Massardier J, Tsatsaris V, Khoshnood B, Lelong N, Delacourt C, Benachi A. Fetal Therapy for Congenital Pulmonary Malformations: A Prospective Population-Based National Cohort Study. Prenat Diagn 2024. [PMID: 39138024 DOI: 10.1002/pd.6646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE To assess the frequency of fetal therapy for fetuses with congenital pulmonary malformations (CPMs) and to investigate their short-term outcomes. METHOD The study population included 435 singleton fetuses diagnosed with CPMs from a national population-based cohort study in France in 2015-2018. Information was obtained from medical records on CPM volume ratio (CVR), signs of compression, fetal therapy and perinatal outcomes. The characteristics and outcomes of fetuses with and without fetal therapy were compared using a univariate test. RESULTS Twenty six fetuses (6.0%, 95% CI: 4.1-8.6) received at least one fetal therapy including thoracoamniotic shunts only (n = 3), antenatal steroids only (n = 12), and a combination of several therapies including thoracentesis and amniodrainage, in addition to shunts and steroids (n = 11). Compared with fetuses without fetal therapy, those who did have higher CVR (1.6 ± 0.3 vs. 0.7 ± 0.04, p < 0.001) and more severe signs of compression (73.1% vs. 12.8%, p < 0.001). The proportion of live births after fetal therapy was 84.6% versus 98.5% (p < 0.001) for those without fetal therapy and the hospital mortality rate was 13.6% versus 1.0% (p = 0.004), respectively. CONCLUSION A small minority of fetuses with CPMs underwent fetal therapy. These patients had a lower survival compared with those who did not receive fetal therapy. TRIAL REGISTRATION NCT02352207.
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Affiliation(s)
- Mathilde Weber
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, Clamart, France
| | - Isabelle Monier
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Makan Rahshenas
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Laurent J Salomon
- Department of Obstetrics, Fetal Medicine and Surgery, EA Fetus 7328 and LUMIERE Platform, University of Paris Cité and Imagine Institute, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Nicolas Sananes
- Maternal Fetal Medicine Department, Strasbourg University Hospital, Inserm 1121 'Biomaterials and Bioengineering', Strasbourg University, Strasbourg, France
| | - Vanina Castaigne
- Service de Gynécologie-Obstétrique, Centre Intercommunal de Créteil, Créteil, France
| | | | - Jean-Marie Jouannic
- Service de Médecine Fœtale, Hôpital Armand Trousseau, AP-HP, Sorbonne Université, Paris, France
| | - Jérôme Massardier
- Service de Gynécologie-Obstétrique et Médecine Fœtale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Vassilis Tsatsaris
- Maternité Port-Royal, Hôpital Cochin, AP-HP, FHU PREMA, Université Paris Cité, Paris, France
| | - Babak Khoshnood
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Nathalie Lelong
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Christophe Delacourt
- Service de Pneumologie et Allergologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, Clamart, France
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Congenital Cystic Adenomatoid Malformation (CCAM) Type II: A Rare Case of Sudden Infant Death. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121830. [PMID: 36553274 PMCID: PMC9776662 DOI: 10.3390/children9121830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Congenital cystic adenomatoid malformation (CCAM) is a developmental lesion of the lungs and terminal respiratory structures, which is characterized by pseudocysts, lesions, and cystically dilated airways. CCAM is also known as congenital pulmonary airway malformation (CPAM). Various classification systems for CCAM have been described, and based on a recent classification, CCAMs are classified morphologically into five different types (Type 0, I, II, III, and IV) based on lesion sizes. The most common manifestation of CCAM in neonates and children is respiratory distress (RD). Spontaneous pneumothorax is a rare manifestation of CCAM. In this case report, we discuss a CCAM type-II case of a 38-day-old female infant with a radiological post-mortem diagnosis of a large left-side spontaneous pneumothorax. The gross examination of the lungs revealed multiple emphysematous air bubbles up to 0.5 cm in diameter, and the histological examination revealed focal pleural fibrosis, accompanied by thickened septa and atelectasis. In this scenario, the routine use of prenatal ultrasonography would be important to obtain a timely prenatal diagnosis. At the same time, improvements in surgical techniques, as well as greatly improved imaging techniques, have improved the outcome of these patients. Finally, it is important to remark on the importance of autopsy in the case of sudden infant death with a suspected CCAM.
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Hara A, Hidaka N, Nitahara K, Sakai A, Kido S, Kato K. Intrathoracic shunt displacement with massive pleural effusion after successful shunt placement in a hydropic fetus with multilocular macrocystic congenital pulmonary airway malformation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:149-153. [PMID: 32562426 DOI: 10.1002/jcu.22886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/30/2020] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Abstract
We successfully performed shunting for a fetus with a multilocular macrocystic lung mass with hydrops at 22 weeks' gestation. Complete resolution of hydrops was achieved; however, at 35 weeks' gestation, the fetus developed acute massive pleural effusion. Fetal ultrasound examination revealed that one end of the shunting tube had migrated downward in the thoracic cavity, which led to fluid draining from the lung cyst. The baby was delivered at term and was discharged following neonatal intensive care management. Intrathoracic displacement of the shunt can occur, followed by massive pleural effusion due to drainage of cystic fluid.
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Affiliation(s)
- Asako Hara
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuhiro Hidaka
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenta Nitahara
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsuhiko Sakai
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Saki Kido
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Sharma D, Tsibizova VI. Current perspective and scope of fetal therapy: part 2. J Matern Fetal Neonatal Med 2020; 35:3812-3830. [PMID: 33135520 DOI: 10.1080/14767058.2020.1839881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fetal therapy has been defined as any therapeutic intervention either invasive or noninvasive for correcting or treating any fetal malformation or condition. Invasive fetal therapy have its own set of maternal and fetal complications and invasive approach is not feasible in many of fetal conditions that are candidate for fetal therapy. Many such fetal conditions have been treated successfully by medical or noninvasive management. In medical fetal therapy, mothers are treated with medications which are transferred to fetus through placenta and exert positive effect on the fetus, thus avoiding complications that are seen secondary to invasive fetal therapy. The fetal conditions that have been managed with medical therapy includes fetal and neonatal alloimmune thrombocytopenia, neural tube defect, congenital adrenal hyperplasia, perinatal infections, respiratory distress syndrome, inborn error of metabolism, and congenital cystic adenomatoid malformation. This review will cover the medical or noninvasive aspect of fetal therapy and will highlight the progress made in the management of these fetal conditions.
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Affiliation(s)
- Deepak Sharma
- Department of Neonatology, National Institute of Medical Science, Jaipur, India
| | - Valentina I Tsibizova
- Almazov National Medical Research Centre, Health Ministry of Russian Federation, Saint Petersburg, Russia
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Chen Y, Zhao B, Xi F, Wang Y, Yang M, Luo Q. The prenatal ultrasonic character and postnatal follow-up of 227 microcystic and macrocystic congenital cystic adenomatoid malformations. J OBSTET GYNAECOL 2020; 41:562-568. [PMID: 32851894 DOI: 10.1080/01443615.2020.1786032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of our study was to compare microcystic and macrocystic congenital cystic adenomatoid malformation (CCAMs) through prenatal characteristics, perinatal outcome, postnatal management and development after consultation in our prenatal diagnosis centre. We conducted a retrospective cohort study of 227 cases prenatally diagnosed as CCAM in our hospital within three years. One hundred and eighty-one cases continued their pregnancy and 46 pregnancies were terminated. One hundred and fifteen of 227 cases were microcystic and 112 were macrocystic. The prenatal ultrasound characteristics of two types showed no statistically significant differences, despite that CVR of macrocystic CCAMs was mildly greater than microcystic. None of recorded cases received surgical intervention in utero. Compared with healthy foetuses, CCAMs presented with higher percentage of polyhydramnios and male foetuses, larger amount of postpartum blood loss and longer duration of NICU hospitalisation. Compared with 46 legal abortions, continued pregnancy cases had a smaller CVR, less polyhydramnios, cardiac shift and hydrops. One hundred and seventy-nine cases were followed up after birth and 174 babies were asymptomatic. Thirty one cases received successful surgical resection. In conclusion, the prenatally diagnosed CCAMs have a good short-term prognosis and conservative management is a reasonable option in asymptomatic fetuses. Microcystic and macrocystic CCAMs both presented similar prenatal courses and perinatal prognoses. Conservative management, prenatally and postnatally, could be accepted in selected cases.Impact statementWhat is already known on this subject? Congenital cystic adenomatoid malformation is a well-known developmental abnormality of the lung. The prognosis for most CCAMs is good, but the prenatal and postnatal management remains controversial.What do the results of this study add? This study is one of the largest case cohorts to conclude that microcystic and macrocystic CCAMs both presented similar prenatal courses and perinatal prognoses. Conservative management is a reasonable option in asymptomatic babies.What are the implications of these findings for clinical practice and/or further research? A comprehensive assessment by an experienced multidisciplinary team is necessary to forbid blinding abortions of CCAMs. Conservative management prenatally and postnatally could be accepted in most asymptomatic cases.
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Affiliation(s)
- Yuan Chen
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baihui Zhao
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangfang Xi
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yayun Wang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengmeng Yang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Sadek S, Chun H. A rare form of congenital high airway obstruction syndrome and a literature review of ex utero intrapartum treatment. CASE REPORTS IN PERINATAL MEDICINE 2018. [DOI: 10.1515/crpm-2017-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objective
This is a rare presentation of a fetus with a right mainstem bronchus occlusion leading to congenital high airway obstruction syndrome (CHAOS).
Methods
A review of 15 articles reporting on the use of the ex utero intrapartum treatment (EXIT) procedure.
Results
A total of 22 reported cases of CHAOS had undergone the EXIT procedure from 1994 to 2016. Seventy-seven percent of fetuses that underwent EXIT were alive at the last point of follow-up, but only 36% were alive without any sequelae.
Conclusion
CHAOS is a rare malformation, but after the development of EXIT, survival is a viable option. It is associated with other malformations, but its etiology is entirely unknown.
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Affiliation(s)
| | - Hajoon Chun
- Flushing hospital Medical Center , Ob Gyn, 4500 parsons Blvd , Flushing, NY 11355 , USA
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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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Takei K, Morikawa M, Cho K, Minakami H. Resolution of tachyarrhythmia-related fetal hydrops after corticosteroid administration for fetal lung maturation. BMJ Case Rep 2015; 2015:bcr-2015-211948. [PMID: 26531736 DOI: 10.1136/bcr-2015-211948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A case of hydrops fetalis (HF) that resolved after corticosteroid therapy despite persisting fetal tachycardia of 190 bpm is reported. The fetus with confirmed normal karyotype had HF in the presence of atrial flutter and sustained ventricular rate of 200-210 bpm at gestational week (GW) 31(-6/7). Aetiologies of HF other than fetal tachyarrhythmia were unlikely in this infant. The patient's family declined pharmacological treatment with maternal digoxin and desired to continue pregnancy with only intensive monitoring of fetal condition. Maternal transplacental β-methasone was given to facilitate fetal lung maturation. The fetal tachyarrhythmia ameliorated to 190 bpm at GW 32(-5/7) and HF gradually disappeared by birth. The otherwise healthy female neonate weighing 3050 g born at GW 37(-0/7) was successfully treated with cardioversion performed 60 min after birth. This case suggested that corticosteroid therapy contributed to the resolution of HF associated with tachyarrhythmia.
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Affiliation(s)
- Kohta Takei
- Maternity and Perinatal Care Center, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mamoru Morikawa
- Maternity and Perinatal Care Center, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazutoshi Cho
- Maternity and Perinatal Care Center, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hisanori Minakami
- Maternity and Perinatal Care Center, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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