Abstract
Aims: This study planned to evaluate fetal non-cardiac thoracic anomalies, which are less common than other organ systems, in terms of diagnosis, incidence, therapy and prognosis.
Methods: The data of 66 cases who were evaluated in a perinatology department between January 2021 and July 2023 with diagnosis of fetal non-cardiac thoracic abnormalities were analyzed retrospectively.
Results: A total of 66 cases were in our study with a mean maternal age of 28.61±4.9 years and a median gestational week of first assessment at our center of 24 weeks (15-38 weeks). The most common non-cardiac thoracic malformation was congenital diaphragmatic hernia (30 cases, 45.4%), followed by congenital pulmonary airway malformation (CPAM) (17 cases, 25.7%). Termination of pregnancy was performed in 4 cases (6.06%). While genetic testing was carried out in a total of 9 cases (13.9%), no chromosomal abnormality was found in any of these cases. In utero interventional procedure was performed in 5 cases (7.57%) and success was achieved in 3 cases. Ten (58.8%) cases with CPAM lesions were resolved during the late antenatal or postnatal period with expectant management. Surgery was performed in 2 (11.8%) of 17 cases with CPAM.
Conclusion: Deliveries of the FNTA cases should be planned in tertiary centers where necessary intervention and care can be provided. A multi-disciplinary team could demonstrate a crucial role in assuring that the pregnant woman and fetus obtain appropriate treatment and are managed during the antenatal and postnatal periods. US plays a crucial role in the diagnosis and management of FNTA cases during the prenatal period rather than fetal MRI and other diagnostic tools. More than half of the CPAM lesions regressed spontaneously with expectant management.
References
- Walker L, Cohen K, Rankin J, Crabbe D. Outcome of prenatally diagnosed congenital lung anomalies in the North of England: a review of 228 cases to aid in prenatal counselling. Prenat Diagn. 2017;37(10):1001-1007.
- Pollak M, Gur M, Bronshtein M, Solt I, Masarweh K, Bentur L. Incidence of congenital thoracic malformations detected by prenatal ultrasound. Pediatr Int. 2020;62(1):89-93.
- Bush A. Prenatal presentation and postnatal management of congenital thoracic malformations. Early Hum Dev. 2009;85(11):679-684.
- Hubbard AM, Harty MP, States LJ. A new tool for prenatal diagnosis: ultrafast fetal MRI. Semin Perinatol. 1999;23(6):437-447.
- Cavoretto P, Molina F, Poggi S, Davenport M, Nicolaides KH. Prenatal diagnosis and outcome of echogenic fetal lung lesions. Ultrasound Obstet Gynecol. 2008;32(6):769-783.
- Andrade CF, Ferreira HP, Fischer GB. Congenital lung malformations. J Bras Pneumol. 2011;37(2):259-271.
- Witlox RS, Lopriore E, Oepkes D. Prenatal interventions for fetal lung lesions. Prenat Diagn. 2011;31(7):628-636.
- Paladini D, Volpe P. Thoracic anomalies. In: Paladini D, Volpe P, edıtors.Ultrasound of congenital fetal anomalies. 2nd edition.2014;p. 233-266.
- Wall J, Coates A. Prenatal imaging and postnatal presentation, diagnosis and management of congenital lung malformations. Curr Opin Pediatr. 2014;26(3):315-319.
- Johnson AM, Hubbard AM. Congenital anomalies of the fetal/neonatal chest. Semin Roentgenol. 2004;39(2):197-214.
- Behram M, Oğlak SC, Acar Z, et al. Fetal cardiac tumors: prenatal diagnosis, management and prognosis in 18 cases. J Turk Ger Gynecol Assoc. 2020;21(4):255-259.
- Behram M, Süzen Çaypınar S, Oğlak SC, Sezer S, Çorbacıoğlu Esmer A. Should isolated aberrant right subclavian artery be ignored in the antenatal period? a management dilemma. Turk J Obstet Gynecol. 2021;18(2):103-108.
- Gedik Özköse Z, Oğlak SC, Bestel A, Behram M, Süzen Çaypınar S, Ölmez F, Özdemir İ. Fetal intracranial hemorrhage: prenatal sonographic diagnosis criteria and postnatal outcomes. J Turk Ger Gynecol Assoc. 2022;23(4):268-274.
- Recio Rodríguez M, Martínez de Vega V, Cano Alonso R, Carrascoso Arranz J, Martínez Ten P, Pérez Pedregosa J. MR imaging of thoracic abnormalities in the fetus. Radiographics. 2012;32(7):E305-21.
- Atalay A, Sahin D. Congenital pulmonary malformations from the prenatal to the postnatal period: tertiary center experience. ACH Med J 2023;2(4):165-172.
- Ionescu C. Thoracic Anomalies [Internet]. Congenital Anomalies - From the Embryo to the Neonate. InTech; 2018. Available from: http://dx.doi.org/10.5772/intechopen.71959.
- Huang M, Gong YH. Treatment of congenital pulmonary airway malformation with rare high cystic volume ratio: a case report and literature review. Medicine (Baltimore). 2023;102(47):e36249.
- Levine D, Barnewolt CE, Mehta TS, Trop I, Estroff J, Wong G. Fetal thoracic abnormalities: MR imaging. Radiology. 2003;228(2):379-388.
- Kaya B, Açar DK, Sezer S. Fetal bronchopulmonary malformations: Prenatal diagnosis and perinatal outcomes. İKSSTD. 2020;12(1):34-38.
- Kosiński P, Wielgoś M. Congenital diaphragmatic hernia: pathogenesis, prenatal diagnosis and management - literature review. Ginekol Pol. 2017;88(1):24-30.
- Grandt J, Gottschalk I, Geipel A, et al. Intrauterine thoracoamniotic shunting of fetal hydrothorax with the somatex intrauterine shunt: intrauterine course and postnatal outcome. J Clin Med. 2022;11(9):2312.
- Klinkner DB, Atwell T, Teles Abrao Trad A, et al. Innovative fetal therapy for a giant congenital pulmonary airway malformation with hydrops. Fetal Diagn Ther. 2022;49(5-6):250-255.
Abstract
Amaç
Çalışmamızda diğer organ sistemlerine göre daha az görülen fetal kalp dışı toraks anomalilerini tanı, insidans, tedavi ve prognoz açısından değerlendirmeyi planladık.
Yöntem
Ocak 2021-Temmuz 2023 tarihleri arasında perinatoloji bölümünde fetal kalp dışı torasik anormallik tanısıyla değerlendirilen 66 olgunun verileri retrospektif olarak incelendi.
Sonuçlar
Çalışmamızda ortalama anne yaşı 28,61±4,9 ve ortalama gebelik haftası 24,5 (en az 15-en çok 38) olan toplam 66 olgu yer aldı. En sık görülen kalp dışı torasik malformasyon konjenital diyafragma hernisi (30 vaka, %45,4) olup bunu konjenital pulmoner hava yolu malformasyonu (CPAM) (17 vaka, %25,7) ve özofagus atrezisi (6 vaka, %9) takip etti. Olguların 4'ünde (%6,06) gebelik sonlandırıldı, toplam 9 olguda (%13,9) genetik araştırma yapılırken, bu olguların hiçbirinde genetik anormal genetik analize rastlanmadı. Beş olguya (%7,57) in utero girişimsel işlem uygulandı ve 3 olguda başarı sağlandı.
Çözüm:
Diğer organ sistemlerine göre daha az sıklıkta gördüğümüz toraks anomalilerinin görülme sıklığı yıllar içinde pek değişmese de tedavi yaklaşımları ve doğum sonrası prognoz yıllar geçtikçe iyileşmektedir. Yeni tedavi yaklaşımlarından bazılarını kullandık ve iyi sonuçlar aldık.
References
- Walker L, Cohen K, Rankin J, Crabbe D. Outcome of prenatally diagnosed congenital lung anomalies in the North of England: a review of 228 cases to aid in prenatal counselling. Prenat Diagn. 2017;37(10):1001-1007.
- Pollak M, Gur M, Bronshtein M, Solt I, Masarweh K, Bentur L. Incidence of congenital thoracic malformations detected by prenatal ultrasound. Pediatr Int. 2020;62(1):89-93.
- Bush A. Prenatal presentation and postnatal management of congenital thoracic malformations. Early Hum Dev. 2009;85(11):679-684.
- Hubbard AM, Harty MP, States LJ. A new tool for prenatal diagnosis: ultrafast fetal MRI. Semin Perinatol. 1999;23(6):437-447.
- Cavoretto P, Molina F, Poggi S, Davenport M, Nicolaides KH. Prenatal diagnosis and outcome of echogenic fetal lung lesions. Ultrasound Obstet Gynecol. 2008;32(6):769-783.
- Andrade CF, Ferreira HP, Fischer GB. Congenital lung malformations. J Bras Pneumol. 2011;37(2):259-271.
- Witlox RS, Lopriore E, Oepkes D. Prenatal interventions for fetal lung lesions. Prenat Diagn. 2011;31(7):628-636.
- Paladini D, Volpe P. Thoracic anomalies. In: Paladini D, Volpe P, edıtors.Ultrasound of congenital fetal anomalies. 2nd edition.2014;p. 233-266.
- Wall J, Coates A. Prenatal imaging and postnatal presentation, diagnosis and management of congenital lung malformations. Curr Opin Pediatr. 2014;26(3):315-319.
- Johnson AM, Hubbard AM. Congenital anomalies of the fetal/neonatal chest. Semin Roentgenol. 2004;39(2):197-214.
- Behram M, Oğlak SC, Acar Z, et al. Fetal cardiac tumors: prenatal diagnosis, management and prognosis in 18 cases. J Turk Ger Gynecol Assoc. 2020;21(4):255-259.
- Behram M, Süzen Çaypınar S, Oğlak SC, Sezer S, Çorbacıoğlu Esmer A. Should isolated aberrant right subclavian artery be ignored in the antenatal period? a management dilemma. Turk J Obstet Gynecol. 2021;18(2):103-108.
- Gedik Özköse Z, Oğlak SC, Bestel A, Behram M, Süzen Çaypınar S, Ölmez F, Özdemir İ. Fetal intracranial hemorrhage: prenatal sonographic diagnosis criteria and postnatal outcomes. J Turk Ger Gynecol Assoc. 2022;23(4):268-274.
- Recio Rodríguez M, Martínez de Vega V, Cano Alonso R, Carrascoso Arranz J, Martínez Ten P, Pérez Pedregosa J. MR imaging of thoracic abnormalities in the fetus. Radiographics. 2012;32(7):E305-21.
- Atalay A, Sahin D. Congenital pulmonary malformations from the prenatal to the postnatal period: tertiary center experience. ACH Med J 2023;2(4):165-172.
- Ionescu C. Thoracic Anomalies [Internet]. Congenital Anomalies - From the Embryo to the Neonate. InTech; 2018. Available from: http://dx.doi.org/10.5772/intechopen.71959.
- Huang M, Gong YH. Treatment of congenital pulmonary airway malformation with rare high cystic volume ratio: a case report and literature review. Medicine (Baltimore). 2023;102(47):e36249.
- Levine D, Barnewolt CE, Mehta TS, Trop I, Estroff J, Wong G. Fetal thoracic abnormalities: MR imaging. Radiology. 2003;228(2):379-388.
- Kaya B, Açar DK, Sezer S. Fetal bronchopulmonary malformations: Prenatal diagnosis and perinatal outcomes. İKSSTD. 2020;12(1):34-38.
- Kosiński P, Wielgoś M. Congenital diaphragmatic hernia: pathogenesis, prenatal diagnosis and management - literature review. Ginekol Pol. 2017;88(1):24-30.
- Grandt J, Gottschalk I, Geipel A, et al. Intrauterine thoracoamniotic shunting of fetal hydrothorax with the somatex intrauterine shunt: intrauterine course and postnatal outcome. J Clin Med. 2022;11(9):2312.
- Klinkner DB, Atwell T, Teles Abrao Trad A, et al. Innovative fetal therapy for a giant congenital pulmonary airway malformation with hydrops. Fetal Diagn Ther. 2022;49(5-6):250-255.
Details
| Primary Language | English |
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| Subjects | Obstetrics and Gynaecology |
| Journal Section | Research Articles [en] Araştırma Makaleleri [tr] |
| Authors | |
| Publication Date | February 29, 2024 |
| Submission Date | December 11, 2023 |
| Acceptance Date | February 28, 2024 |
| Published in Issue | Year 2024 Volume: 5 Issue: 1 |
TR DİZİN ULAKBİM and International Indexes (1d)
Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]
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