Perinatal outcome after minimally invasive fetal therapy for cystic lung lesions

Introduction: The aim of this study was to evaluate the perinatal survival after minimally invasive fetal therapy in fetuses with severe CPAM or BPS.

Material and methods: A retrospective study (2000 – 2013) was performed at the University Hospital Zurich including 36 pregnancies with a fetal CPAM or BPS. In 9 fetuses a minimally invasive therapy was performed including amniotic fluid reduction (N = 12), thoracocentesis (N = 18) and placement of a thoracoamniotic shunt (N = 7). Primary endpoint was perinatal survival. Data are quoted as means and standard deviations (SD).

Results: Fetal interventions were performed in 6/26 (23%) and 3/10 (30%) fetuses with CPAM and BPS, respectively. The indication for intervention was hyprops fetalis in 6/9 (67%) and polyhydramnios with resulting preterm contractions and fetal mediastinal shift in 3/9 (33%) cases.

Interventions were performed at 29.7 (± 3.3) gestational weeks. In all but one pregnancies interventions had to be performed repeatedly (1 – 8 times). Mean gestational age at delivery was 36.4 (± 2.3) weeks. Perinatal survival was 92% and 75% in all or hydropic BPS fetuses and 66% and 50% in all or hydropic CPAM fetuses, respectively. The two neonatal deaths occurred after serial thoracocentesis. Eight newborns were transferred to neonatal intensive care unit and needed invasive neonatal treatment or urgent surgery during early neonatal period.

Conclusion: Perinatal survival of fetuses with severe cystic lung lesions after fetal interventions was 78%. After minimally invasive fetal therapy delivery should be planned at a specialized perinatal centre with neonatal intensive care and the possibility for immediate pediatric surgical intervention.