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Objective@#To explore the perinatal outcome of antenatally diagnosed primary fetal hydrothorax (FHT), and to provide management experience for FHT.@*Methods@#The clinical data of 80 cases with FHT, from January 2014 to February 2018 in Guangdong Women and Children Hospital, were retrospectively analyzed.@*Results@#Among 80 cases of FHT, the median age of the pregnant women was 29 years old (24-33 years old), while the median gestational age at diagnosis was 29+ 1 weeks(24-32 weeks), among them, 9 cases were lost to follow-up.Among the other 71 cases, 48 cases(67.6%) developed fetal edema, 44 cases (62.0%) involved bilateral pleural effusion, and 35 cases (49.3%) were associated with polyhydramnios.The rate of thoracoamniotic shunting and thoracentesis were 29.6% (21/71 cases) and 7.0% (5/71 cases), respectively.Among 71 cases of FHT, the overall survival rate was 63.4% (45/71 cases), the rate of termination of pregnancy was 22.5% (16/71 cases), including 2 cases which were chosen for termination of pregnancy after thoracoamniotic shunting due to poor control.Among the 55 continued gestation cases, 7 cases died in uterus, and the survival rate of fetal hydropic cases and non-hydropic cases was 70.6% and 100.0%, respectively, and the difference was statistically significant(P<0.05). Among the 48 cases of hydropic cases, there were 34 cases (70.8%) chosen to continue the pregnancy, the survival rate of non-intervention group (13 cases), thoracentesis group (4 cases) and thoracoamniotic shunting group (17 cases) were 53.8%, 75.0% and 82.4%, respectively, and the difference was statistically significant (P<0.05).@*Conclusions@#Fetal hydrops predicted a poor prognosis in PFHT.Timely intrauterine intervention could effectively improve the prognosis of PFHT and improve the survival rate.
ABSTRACT
Objective To explore the perinatal outcome of antenatally diagnosed primary fetal hydrothorax (FHT),and to provide management experience for FHT. Methods The clinical data of 80 cases with FHT,from January 2014 to February 2018 in Guangdong Women and Children Hospital,were retrospectively analyzed. Results Among 80 cases of FHT,the median age of the pregnant women was 29 years old(24-33 years old),while the median gestational age at diagnosis was 29+1 weeks(24 -32 weeks),among them,9 cases were lost to follow-up. Among the other 71 cases,48 cases(67. 6% )developed fetal edema,44 cases(62. 0% )involved bilateral pleural effusion,and 35 cases (49. 3% )were associated with polyhydramnios. The rate of thoracoamniotic shunting and thoracentesis were 29. 6% (21/71 cases)and 7. 0% (5/71 cases),respectively. Among 71 cases of FHT,the overall survival rate was 63. 4% (45/71 cases),the rate of termination of pregnancy was 22. 5%(16/71 cases),including 2 cases which were chosen for termination of pregnancy after thoracoamniotic shunting due to poor control. Among the 55 continued gestation cases,7 cases died in uterus,and the survival rate of fetal hydropic cases and non-hydropic cases was 70. 6% and 100. 0% ,re-spectively,and the difference was statistically significant(P<0. 05). Among the 48 cases of hydropic cases,there were 34 cases(70. 8% )chosen to continue the pregnancy,the survival rate of non-intervention group(13 cases),thoracentesis group(4 cases)and thoracoamniotic shunting group(17 cases)were 53. 8% ,75. 0% and 82. 4% ,respectively,and the difference was statistically significant( P<0. 05). Conclusions Fetal hydrops predicted a poor prognosis in PFHT. Timely intrauterine intervention could effectively improve the prognosis of PFHT and improve the survival rate.
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Objective@#To investigate the effect of intrauterine intervention on severe primary fetal hydrothorax.@*Methods@#Twelve cases with severe fetal primary hydrothorax who underwent prenatal intervention from January 2014 to December 2017 in Guangdong Women and Children Hospital were retrospectively reviewed.@*Results@#The median gestational age of prenatal diagnosis was 30.8 weeks (24.0-33.0 weeks) . All cases were excluded congenital chromosomal abnormalities by prenatal diagnosis, and had no complications of pregnancy during prenatal diagnosis and had hydrothorax. Three cases (3/12) were right hydrothorax, the other 9 cases (9/12) were bilateral. Thoracoamniotic shunting was performed in 7 cases (7/12) . Thoracentesis was performed in 5 cases (5/12) , and the hydrothorax reappeared soon after operation in 4 cases, shunt placement was performed again. The hydrothorax was dissolved in 2 cases, released in 6 cases.Tube falling off occurred in 1 case,treatment was abandoned in 1 case and intrauterine fetal death happened in 1 case, and 1 case wasn′t rechecked by ultrasonic due to premature birth following thoracentesis. In 10 cases who had deliveries, 5 newborns (5/10) were premature, 6 newborns (6/10) underwent assisted mechanical ventilation, 8 newborns (8/10) underwent thoracic close drainage, all of them were discharged when hydrothorax resolved.@*Conclusions@#Antenatal intervention may improve the chance of survival in severe primary fetal hydrothorax. Thoracoamniotic shunting is the first-choice for the primary severe fetal hydrothorax.
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Objective To share our experiences on integrated services in providing fetal diagnosis and postnatal treatment for congenital diaphragmatic hernia(CDH).Methods A retrospective analysis was conducted on 25 pregnancies diagnosed as CDH by both prenatal ultrasound and MRI in Maternal and Children Hospital of Guangdong Province from January 2012 to January 2014.All of the subjects received integral medical management including prenatal management (prenatal diagnosis and consultation), perinatal management (prenatal care and delivery) and neonatal treatment.Results Among the 25 CDH fetuses, 11 were mild, nine were moderate, and five were severe.One severe case, who was diagnosed at 26 gestational weeks, was aborted on demand of the mother.The other 24 cases continued their pregnancy and all delivered after 35 weeks including 13 cesarean sections (one due to twin pregnancy and 12 due to maternal demand) and 11 vaginal birth.The mean gestational age when CDH was diagnosed was (24.5 ± 3.5) weeks, and the 24 women delivered at an average of (37.5 ± 1.4) gestational weeks.The eleven mild cases accepted mask oxygenation.For those 13 moderate or severe CDH cases, all received dexamethasone to promote fetal lung maturity at 32 gestational weeks, seven were intubated before clamp the cord, and the other six did after.These 13 babies accepted high-frequency oscillation ventilation, with a median duration of 58 hours, and some of them treated with inhaled nitric oxide on requirement with a median duration of 52 hours.Except two cases died before operation, the rest 22 cases underwent neonatal surgery.One moderate case died at 48 hours after surgery due to pulmonary hypertension and respiratory failure.Another one severe case withdrew treatment at two months old.The other 20 infants recovered fully.Conclusions Integrated management including prenatal diagnosis and postnatal treatment, provides an effective and streamlined mode for diagnosis and treatment of CDH.Therefore,it might minimize potential medical risks.
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Objective To discuss the diagnosis and early intervention treatment of fetal congenital broncho-genic cysts based on the cases reviewed. Methods The clinical features of 7 infants presenting bronchogenic cysts diagnosed antenatally from January 2013 to May 2014 in Guangdong Women and Children's Hospital and Health In-stitute were reviewed retrospectively. Pathology,the prenatal diagnosis and treatment of bronchogenic cysts experience were summarized combined with CT after birth and surgery. Results Based on the prenatal diagnosis of fetal and postnatal CT and surgical pathology,a total of 7 cases with congenital bronchial cysts were diagnosed. Of which 4 ca-ses were suggestive of congenital cystsic adenomatoid malformation by prenatal diagnosis,and the other 3 cases had fetal bronchial cysts by prenatal diagnosis,antenatal diagnosis was accurate in 42. 9%(3 / 7 cases). CT examinations were taken in 7 cases after birth,and the cyst excision was performed on them with surgery thoracic approach;the average age at surgery was(5. 3 ± 1. 7)months. Four cases had simple bronchial cystss,2 cases with congenital cystsic adenomatoid malformation,1 case with congenital pulmonary sequestration. The accuracy of CT diagnosis was 85. 7%(6 / 7 cases). All surgical treatment was effective. Conclusions Fetal bronchial cysts is always associated with the other presence of lung congenital malformations. Prenatal diagnosis of congenital bronchial cysts is difficult. Prenatal diagnosis is difficult to exclude congenital cystsic adenomatoid malformation. To avoid symptoms like oppres-sion,infection,prenatal diagnosis combined with CT examination after birth and early treatment are necessary and reliable clinically.