OP02.03: Maternal hyperoxygenation test in fetuses with congenital diaphragmatic hernia and correlations with neonatal respiratory function

Abstract

Objectives: The natural history of echogenic lung lesions such as congenital cystic adenomatoid malformation (CCAM) and pulmonary sequestration (PS) has been altered by the advent of antenatal ultrasonography. Initial reports were characterized by a high incidence of adverse features (hydrops) and a poor outcome and did not accord with recent experience. Our purpose was to review the evolution and outcome of these lesions in our series. Methods: A retrospective review was conducted on fetuses diagnosed antenatally in the Fetal Medicine Unit of Hospital Vall d Hebron in Barcelona, Spain, between 2001 and 2007. A computer search identified all referred cases, and the records of these patients were examined to determine the pregnancy outcome. Results: In a 6-year period, 34 fetuses with echogenic lung lesions were referred for further management. The median age at diagnosis was 23 (range, 20–41) weeks. The lesion was on the right side in 19 (55%) and 15 (45%). All cases were unilateral. One case was diagnosed as CCAM type I (3%), 14 CCAM type II (41%) 11 CCAM type III (32%), 3 PS (8.8%) and five were mixed PS/CCAM (15%). All the fetuses had no associated anomalies and normal karyotype except one (47 XX+18). Termination of pregnancy was performed in seven cases of CCAM. In all cases histologic examination showed definitive diagnostic features of CCAM. In two cases diagnostic type of CCAM was changed from CCAM type II to type I and from CCAM type III to type II. Mediastinal shift was present in 16 fetuses (47%). Severe signs of fetal distress (hydrops) were present in three (8.8%). Because of hydrops, antenatal intervention was performed in two fetuses (thoracoamniotic shunting) and it was resolved. During the course of the pregnancy 70.5% (24/34) cases reduced in size or resolved spontaneously. All cases had good perinatal outcome. Conclusions: Most cases of prenatally diagnosed echogenic lung lesions had a good outcome. This review has positively influenced the counseling of women with this diagnosis.