title: Congenital Lung Lesion: Prenatal Course, Therapy and Predictors of Perinatal Outcome.
abstract: PurposeTo describe the prenatal course and perinatal outcome, and to define prognostic markers for fetuses with congenital pulmonary airway malformation (CPAM) or bronchopulmonary sequestration (BPS).Materials and MethodsA retrospective study was performed at the University Hospital Zurich including pregnancies with either fetal CPAM (n = 26) or BPS (n = 11) between 2000 and 2013.ResultsThree patients decided for termination of pregnancy. Two intrauterine deaths (CPAM) occurred at 25 weeks. Minimally invasive interventions were performed in 9/37 (24 %) fetuses, post-interventional survival was 8/9 (89 %). Mean gestational age at delivery was 38.1 +/-2.8 and 39.1 +/-2.5 weeks in fetuses with CPAM or BPS, respectively. In fetuses with CPAM the perinatal mortality rate was 4/24 (17 %); the rate of invasive interventions or surgery during the early neonatal period (neonatal morbidity) was 9/22 (41 %). Prenatal diagnosis of hydrothorax and/or increasing cystic volume ratio (CVR) until delivery preceded perinatal death in 3/5 (60 %). Absent mediastinal shift showed a neonatal morbidity rate of 1/8 (13 %) without any perinatal mortality. In fetuses with BPS the perinatal morbidity and mortality were both 1/10 (10 %). Hydrops predicted morbidity and mortality in 100 % of cases. Absent hydrops was followed by uncomplicated perinatal outcome.ConclusionFetuses with CPAM or BPS have a good outcome under optimal perinatal care including the possibility to perform minimally invasive prenatal interventions. CPAM without mediastinal shift and BPS without hydrops have an excellent prognosis. Hydrothorax, increasing CVR or hydrops indicates a high risk for perinatal morbidity and mortality.
authors.affiliation: Department of Obstetrics, University Hospital Zurich, Zürich, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Stoiber
authors.affiliation: Department of Surgery, University Children's Hospital Zurich, Zürich, Switzerland.
authors.forename: Ueli
authors.initials: U
authors.lastname: Moehrlen
authors.affiliation: Department of Obstetrics, University Hospital Zurich, Zürich, Switzerland.
authors.forename: Jouzas
authors.initials: J
authors.lastname: Kurmanavicius
authors.affiliation: Department of Surgery, University Children's Hospital Zurich, Zürich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Meuli
authors.affiliation: Department of Obstetrics, University Hospital Zurich, Zürich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Haslinger
authors.affiliation: Department of Obstetrics, University Hospital Zurich, Zürich, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Zimmermann
authors.affiliation: Department of Obstetrics, University Hospital Zurich, Zürich, Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ochsenbein
mesh_terms: D000025:Abortion, Eugenic; D001998:Bronchopulmonary Sequestration / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011379:Prognosis; D015619:Respiratory System Abnormalities / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D013908:Thoracotomy; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal