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Outcome of fetal congenital pulmonary malformations: a systematic review and meta-analysis
Filomena Giulia Sileo1,2, Sara Alameddine3, Daniela Anna Iaccarino3
1Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy.
Insights
Congenital lung malformations (CLMs) in fetuses often show favorable outcomes, with about 31% regressing in size during pregnancy. However, evidence on fetal therapy
Area of Science:
- Prenatal diagnosis and management of fetal anomalies.
- Fetal medicine and obstetrics.
- Pediatric surgery and pulmonology.
Background:
- Congenital lung malformations (CLMs) are a diverse group of fetal lung anomalies.
- CLMs exhibit variable presentations, from asymptomatic lesions to severe conditions requiring intervention.
- Prenatal diagnosis allows for assessment of in-utero natural history and potential interventions.
Conclusions:
- Fetuses with prenatally diagnosed CLM generally have a favorable outcome.
- The quality of evidence regarding the role of fetal therapy in improving CLM outcomes is low.
- Further research is needed to clarify the efficacy of fetal interventions for CLMs.
Objectives:
To report the outcome of fetuses with a prenatal diagnosis of congenital lung malformation (CLM) diagnosed on ultrasound by performing a comprehensive assessment of these outcomes through a systematic review and meta-analysis.
Content:
CLMs are a heterogeneous group of anomalies that involve the lung parenchyma and its bronchovascular structures. Their presentation and evolution are variable, from entirely asymptomatic lesions with sonographic regression in utero to hydropic fetuses requiring fetal therapy, intrauterine death or neonatal morbidity. A systematic review was conducted in Medline, Embase and Cochrane databases including studies on fetuses with CLM diagnosed prenatally in order to report the in-utero natural history of these lesions. Thirty-nine studies (2,638 fetuses) were included in the final review.
Summary:
Regression/reduction in size of the lung lesion during pregnancy was reported in 31 % of cases, while its increase in 8.5 % of cases. Intra-uterine death complicated 1.5 % of pregnancies with fetal CLM, while neonatal and perinatal death were 2.2 and 3 %, respectively. Neonatal morbidity occurred in 20.6 % of newborns with CLM; 46 % had surgery, mainly elective. In fetuses with CLM and hydrops, fetal/perinatal loss occurred in 42 %. Assessment of the role of fetal therapy in improving the outcomes of pregnancies complicated by CLM was hampered by the small number of included cases and heterogeneity of type of interventions.
Outlook:
Fetuses with CLM prenatally diagnosed have a generally favorable outcome. Conversely, there is a low quality of evidence on the actual role of fetal therapy in improving the outcome of fetuses presenting with these anomalies.
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