Prenatal Prediction of Pulmonary Hypoplasia: Clinical, Biometric, and Doppler Velocity Correlates

Abstract

ABSTRACT. Objectives. To determine the value of pulmonary artery Doppler velocimetry relative to fetal biometric indices and clinical correlates in the prenatal prediction of lethal lung hypoplasia (LH) in prolonged (>1 week) oligohydramnios.Methods. Forty-two singleton pregnancies with oligohydramnios associated with premature rupture of membranes ([PROM]; n ‫؍‬ 31) or bilateral renal pathology (n ‫؍‬ 11) were examined using color-coded Doppler ultrasound in a cross-sectional study design. Mean gestational age was 28.0 ؎ 4.3 weeks (range: 20 -36 weeks). Thoracic, cardiac, and abdominal circumference and the largest vertical amniotic fluid pocket were measured. Pulsed Doppler measurements of the arterial pulmonary branches were made at the level of the cardiac 4-chamber view. Diagnosis of LH was based on clinical, radiologic, and pathologic criteria. Clinicians were blinded to the prenatal measurements.Results. The prevalence of lethal LH was 43%. In the PROM subset, combination of onset of PROM at <20 weeks, duration of oligohydramnios at >8 weeks, and degree of oligohydramnios at <1 cm presented the highest clinical prediction rate for lethal LH. For both the total group and the PROM subset, the highest prediction rate for lethal LH was presented by thoracic circumference/ abdominal circumference ratio, peak systolic velocity in the proximal branch, and time-averaged and end-diastolic velocity in the middle branch of the pulmonary artery. In the PROM subset, the combination of all 3 clinical, biometric, and Doppler parameters revealed the most favorable combination to predict lethal LH (positive predictive value: 100%; accuracy: 93%; and sensitivity: 71%).Conclusion. Doppler velocimetry may detect changes in pulmonary artery waveforms in the presence of LH but fails to be the ultimate test for the prenatal prediction of lethal LH. The best prediction can be achieved by combining clinical, biometric, and Doppler parameters. Pediatrics 2002;109:250 -258; human fetus, pulmonary hypoplasia, pulmonary circulation, premature rupture of membranes, oligohydramnios, Doppler velocimetry.

Preterm Premature Rupture of the Membranes: Current Approaches to Evaluation and Management

“…Over a period of weeks, the lungs fail to grow in pace with the remainder of the fetus. This is manifest on ultrasound as a lag in chest circumference, chest-abdomen ratio, or lung length, among other indirect parameters of pulmonary growth [15,33,34]. Because the lag in lung growth likely reflects the results of an earlier insult rather than an ongoing process, it is unlikely that earlier delivery enhances outcome once pulmonary hypoplasia is suspected.…”

Lung hypoplasia and its associated major congenital abnormalities in perinatal death: An autopsy study of 850 cases

“…Combination of onset of premature rupture of membranes at <=20 weeks, duration of oligohydramnios at >=8 weeks, and degree of oligohydramnios at <=1 cm presented the highest clinical prediction rate for lethal LH. 13 From 163 cases of preterm rupture of amniotic membrane 21 cases (12.9) were developed LH in the study done by Winn in year 2000. There was a 54% mortality rate among the patients in this study.…”

Bronchopulmonale Dysplasie und Langzeitfolgen

“…SSW, mit einem O2-Bedarf von über 25 % am 14. Lebenstag, eine Wahrscheinlichkeit von 50 %, eine BPD zu entwickeln [4].…”