Bronchopulmonary Sequestration with Fetal Hydrops in a Monochorionic Twin Successfully Treated with Multiple Courses of Betamethasone

Abstract

Aim We present a case of severe bronchopulmonary sequestration (BPS) and fetal hydrops in one of the monochorionic twin successfully treated with multiple courses of betamethasone.

Case Report A 21-year-old gravida 2 para 1 was referred to our hospital for suspected twin-to-twin transfusion syndrome (TTTS) at 28^0/7 weeks of gestational age. However, prenatal ultrasound of the larger twin revealed a chest lesion that was associated with significant ascites, massive hydrothorax, scant hepatomegaly, subcutaneous edema, and severe polyhydramnios. Magnetic resonance imaging confirmed the diagnosis of BPS and fetal hydrops. The estimated fetal weight discrepancy between the fetuses was 39% but the criteria for TTTS were not met. Repeated courses of betamethasone (3 courses, each with 2 × 14 mg of betamethasone intramuscularly/week) were administered with subsequent recovery from hydrops and reduction in BPS parameters. Amniodrainage was performed twice to reduce the amniotic fluid amount in affected twin. Postnatally, surgery of BPS was not required and follow-up at 6 months of corrected age revealed no side effects of antenatal steroids in either twin.

Conclusion Antenatal steroids might be considered for noninvasive therapy in high-risk fetal patients with BPS especially when fetal intervention is unsuitable or not available.

Keywords

bronchopulmonary sequestration - hydrops - monochorionic twins - antenatal steroids - neonatal outcome

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