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Management Options for Fetal Bronchopulmonary Sequestration.

Magdalena Litwinska1, Ewelina Litwinska1, Krzysztof Szaflik2

  • 1Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-091 Warszawa, Poland.

Journal of Clinical Medicine
|March 25, 2022
PubMed
Summary

Expectant management is safe for fetuses with bronchopulmonary sequestration (BPS) without hydrops. For hydropic fetuses, minimally invasive intrauterine therapies, particularly laser coagulation, significantly reduce preterm birth and the need for postnatal surgery compared to thoraco-amniotic shunts.

Keywords:
bronchopulmonary sequestrationfetal therapylaser coagulation of the feeding vesselthoraco-amniotic shunt

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Area of Science:

  • Perinatal Medicine
  • Fetal Surgery
  • Pulmonology

Background:

  • Bronchopulmonary sequestration (BPS) is a congenital lung malformation with variable prenatal presentation.
  • Hydrops fetalis associated with BPS indicates a poor prognosis without intervention.

Purpose of the Study:

  • To evaluate prenatal course and perinatal outcomes of fetuses with BPS.
  • To compare expectant management with minimally invasive intrauterine interventions for BPS.
  • To assess the efficacy of different percutaneous interventions for BPS-associated hydrops.

Main Methods:

  • Retrospective study of 29 fetuses with suspected BPS (2010-2021) across three Polish fetal medicine centers.
  • Literature search (Medline) for expectant or minimally invasive BPS management cases.
  • Analysis of outcomes including survival, preterm birth rates, and need for postnatal surgery.

Main Results:

  • Expectant management was used for 16 fetuses without cardiac compromise.
  • Thirteen hydropic fetuses underwent intrauterine intervention: thoraco-amniotic shunt (TAS) in 5, laser coagulation in 7, and combined treatment in 1.
  • Laser coagulation showed higher survival (98.1%) and significantly lower rates of preterm birth (14.3%) and postnatal sequestrectomy (23.5%) compared to TAS (84.6% preterm birth, 84% postnatal surgery).

Conclusions:

  • Fetuses with BPS without hydrops have a low risk of progression and cardiac compromise with expectant management.
  • Intrauterine therapy for hydropic BPS prevents fetal demise.
  • Laser coagulation is superior to TAS in reducing preterm birth and the need for postnatal surgery in hydropic BPS cases.