209: Obstetric and neonatal outcomes in pregnancies complicated by fetal lung masses: does final histology matter?

Abstract

The predicted etiology of prenatally diagnosed fetal lung masses is not always consistent with lung mass histology at the time of neonatal resection. Most data to date describe outcomes based on prenatal imaging characteristics. Our aim was to assess obstetric and neonatal outcomes by fetal lung mass histology. We reviewed all pregnancies complicated by fetal lung mass from a single academic center from 2009-2017. For the current analysis, only those with prenatal and neonatal data, including final histology data, were included. Maternal demographics, prenatal imaging, obstetric and neonatal outcomes were analyzed and compared between lung mass histologic categories: bronchopulmonary sequestration (BPS) and congenital pulmonary airway malformation (CPAM) subtypes. The primary composite outcome was neonatal respiratory distress defined as any of: continuous positive airway pressure; intubation and mechanical ventilation; extracorporeal membrane oxygenation; or resection of the lung mass before neonatal discharge. Of 60 pregnancies complicated by fetal lung mass during the study period, 43 had prenatal, postnatal, and final histology data. Of those, there were 10 cases of CPAM type 1, 9 cases of CPAM type 2, and 16 cases of BPS. There was 1 case of CPAM type 3, which was not included in the analysis due to low incidence. Maternal age, race/ethnicity, insurance status, and parity were similar between histologic categories. There was no difference in gestational age at delivery, IUGR, mode of delivery, birthweight, or Apgar scores between groups. PPROM was the only adverse outcome that approached statistical significance (0% in CPAM type 1, 33.3% in CPAM type 2, 6.2% in BPS, p = 0.07). Neonatal respiratory distress was not statistically different between the groups (30.0% in CPAM type 1, 22.2% in CPAM type 2, 43.8% in BPS, p = 0.66), and there was no difference in neonatal length of stay, time to postnatal resection, or neonatal mortality (Table). Final histology of a prenatally diagnosed fetal lung mass may not be associated with different obstetric and neonatal outcomes, including respiratory distress at birth. Our results can inform fetal surveillance and maternal counseling.