Perinatal Safe Management by Repeated Fetal Therapies for a Case of Pulmonary Sequestration With Fetal Hydrops
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- Iwasaki Shun
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine
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- Saka Ryuta
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine
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- Tazuke Yuko
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine
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- Okuyama Hiroomi
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine
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- Nagamine Yukie
- Department of Medical Technology, Center for Maternal, Fetal and Neonatal Medicine, Osaka University Hospital
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- Harada Hiromi
- Department of Medical Technology, Center for Maternal, Fetal and Neonatal Medicine, Osaka University Hospital
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- Mimura Kazuya
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine
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- Endo Masayuki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine
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- Watanabe Miho
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine
Bibliographic Information
- Other Title
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- 胎児治療を繰り返すことにより胎児水腫が改善し満期まで妊娠継続できた肺葉外肺分画症の1例
Abstract
<p>Bronchopulmonary sequestration (BPS) is the second most common congenital cystic lung disease. The size of the lesion generally increases until 25 weeks of gestation and decreases after 28 weeks of gestation. This finding is similar to the reported growth trajectory of congenital pulmonary airway malformation (CPAM), for which the mean CPAM volume ratio (CVR) peaks at 25 weeks of gestation. However, the peak of CVR in patients with extralobar BPSs associated with hydrops is lower than that of the CVR associated with hydrops in patients with CPAM. A CVR cutoff of 0.75 has been utilized as a useful predictor of fetal hydrops and a possible requisite of fetal therapies. We report a case of extralobar pulmonary sequestration. The patient initially showed massive pleural effusion and rightward cardiac deviation at 26 weeks of gestation, followed by the development of hydrops with a CVR of up to 1.5 at 28 weeks of gestation. A total of seven fetal therapies, namely, two maternal steroids, three thoracenteses, and two thoracoamniotic shunts, were performed between 26 and 35 weeks of gestation, resulting in the resolution of hydrops by the 35th week of gestation, shrinkage of BPS at a CVR down to 0.23, and full-term birth by vaginal delivery. Stable perinatal management without any emergent surgical intervention was achieved. Aggressive fetal therapies were very useful for the survival of BPS patients with hydrops and safety in perinatal management.</p>
Journal
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- Journal of the Japanese Society of Pediatric Surgeons
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Journal of the Japanese Society of Pediatric Surgeons 58 (6), 907-911, 2022-10-20
The Japanese Society of Pediatric Surgeons
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Details 詳細情報について
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- CRID
- 1390012335398926976
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- ISSN
- 21874247
- 0288609X
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- Text Lang
- ja
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- Data Source
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- JaLC
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- Abstract License Flag
- Disallowed