Prenatal diagnosis, treatment and outcomes of fetal bronchopulmonary sequestration-analysis of 68 cases

Abstract

Objective To review and analyze the prenatal diagnosis and treatment of fetal bronchopulmonary sequestration (BPS).Methods Data of 68 BPS fetuses in the Department of Fetal Medicine,Guangdong Women and Children Hospital and Health Institute from January 20,2009 to January 31,2013 were reviewed.All of the 68 fetuses were diagnosed by ultrasound and volume to head circumference ratio (CVR) was measured.Postnatal surgeries at neonatal or infantile period were performed and babies were followed-up.Results With antenatal ultrasonography,fetal chest solid or hyper-echoic mass was found in all 68 cases at an average of 24 weeks of gestation (18-30 weeks) and were diagnosed as BPS after at least twice ultrasound scans.CVR was measured in these 68 cases,among them 56 cases (82.4％) were ＜1.6,and 12 cases (17.6％) were ≥1.6.Among the 12 cases with CVR≥1.6,seven developed fetal hydrops.Except for two terminated pregnancies because of CVR≥ 1.6 with fetal hydrops,all of the rest 66 cases continued their pregnancies till birth and 58 (87.9％) neonates were asymptomatic and eight (12.1％) were symptomatic.The mass was undetectable with ultrasonography in 18 fetuses during the third trimester,however,the mass was identifed again under CT scan after birth in 14 cases (another four cases unexamined).There were totally 45 cases fully recovered after lobectomy or BPS resection after birth,among which five cases underwent emergency surgery in neonatal period.Pathology results showed that 12 cases were intra-lobar and 33 cases were extra-lobar type.Totally,six cases were diagnosed as BPS under diaphragm.Sixty cases were followed up at three months to two years after birth,and all developed well and CT scan indicated normal pulmonary function.Conclusions Most BPS fetuses without hydrops have a good outcome.Fetus with BPS could wait for full term delivery following professional evaluation and standard protocol.However,the prognosis of BPS with fetal hydrops depends on prenatal evaluation and early surgical intervention.And the effect of early surgical intervention in BPS neonates is satisfied.CVR is the most important index for prenatal evaluation of BPS and CT scan after birth is critical for those babies with undetectable mass by prenatal ultrasound. Key words: Bronchopulmonary sequestration; Ultrasonography, prenatal; Infant, newborn; Surgical procedures, operative