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Maternal hyperoxygenation test in fetuses undergoing FETO for severe isolated congenital diaphragmatic hernia
Author(s) -
Done E.,
Allegaert K.,
Lewi P.,
Jani J.,
Gucciardo L.,
Van Mieghem T.,
Gratacos E.,
Devlieger R.,
Van Schoubroeck D.,
Deprest J.
Publication year - 2011
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.7753
Subject(s) - medicine , congenital diaphragmatic hernia , pulmonary hypertension , fetus , diaphragmatic hernia , pulmonary artery , lung , diaphragmatic breathing , surgery , anesthesia , cardiology , hernia , pregnancy , pathology , genetics , alternative medicine , biology
Objectives To predict neonatal survival and pulmonary hypertension by measurement of fetal pulmonary artery reactivity to maternal hyperoxygenation in fetuses with severe congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO). Methods Thirty‐eight fetuses underwent FETO at around 28 weeks' gestation and the balloon was removed at 34 weeks in most cases. We performed a hyperoxygenation test and measured the lung‐to‐head ratio of each fetus before and after each procedure. Outcome measures were neonatal survival, occurrence of pulmonary hypertension and its response to inhaled nitric oxide (iNO). Results Fetuses that survived had a larger increase in lung size and decrease of resistance in the first branch of the main pulmonary artery than did those that died. Both measures were also predictive of pulmonary hypertension unresponsive to iNO. The hyperoxygenation test and lung‐to‐head ratio were both best predictive for neonatal survival when measured following removal of the balloon ( P < 0.002). Discriminant analysis confirmed that these two parameters are independent predictors of outcome. Conclusions In fetuses undergoing FETO, pulmonary vascular reactivity in relation to oxygen and lung size are independent predictors of neonatal survival and pulmonary hypertension. The hyperoxygenation test merits further study in expectantly managed cases. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.