Comparison of six different ultrasonographic methods for predicting lethal fetal pulmonary hypoplasia

doi:10.1016/0002-9378(89)90363-3

American Journal of Obstetrics and Gynecology

Volume 161, Issue 3, September 1989, Pages 606-612

https://doi.org/10.1016/0002-9378(89)90363-3 Get rights and content

Abstract

Nomograms of six different ultrasonographic fetal parameters were established by studying uncomplicated, singleton pregnancies, with well-established dates, between 16 and 40 weeks of gestation. The studied parameters could reflect fetal lung mass and included the following: chest circumference (CC), chest area (CA), chest area minus heart area (CA - HA), chest circumference/abdominal circumference ratio (CC x 100/AC), chest area/heart area ratio (CAMA), and chest area minus heart area divided by chest area ratio [(CA - HA) x 100/CA]. The effect of ruptured membranes on these six ultrasonographic parameters was assessed by studying patients who had premature rupture of the membranes of < 1 week's duration. It was found that premature rupture of the membranes is associated with increased frequency of CC, CA, and CA - HA measurements at or below the 5th percentile. However, in patients with premature rupture of the membranes all measurements were within the normal range for the three ratios. The efficacy of each of the six parameters was determined by studying 13 fetuses at high risk for development of lethal pulmonary hypoplasia. The (CA - HA) x 100/CA parameter had the best diagnostic accuracy (sensitivity 85%, specificity 85%, positive predictive value 83%, and negative predictive value 85%).

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Assessment of the fetal lungs in utero
2022, American Journal of Obstetrics and Gynecology MFM
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Overall, there is limited accuracy of imaging biometric parameters in the prediction of pulmonary hypoplasia in midtrimester PPROM,88 but some recent evaluations of o/e LHR and QLI in live birth with PPROM occurring before 24 weeks of gestation proved valuable in predicting lethality.89 Moreover, lower-chest-area-to-heart-area mean ratios were established to be lower than those of controls, and predictive of lethal pulmonary hypoplasia when below the fifth percentile.59 MRI has been used to evaluate lung volumetry and its correlation with postnatal outcome in fetuses with second-trimester PPROM.
Antenatal diagnosis of abnormal pulmonary development has improved significantly over recent years because of progress in imaging techniques. Two-dimensional ultrasound is the mainstay of investigation of pulmonary pathology during pregnancy, providing good prognostication in conditions such as congenital diaphragmatic hernia; however, it is less validated in other high-risk groups such as those with congenital pulmonary airway malformation or preterm premature rupture of membranes. Three-dimensional assessment of lung volume and size is now possible using ultrasound or magnetic resonance imaging; however, the use of these techniques is still limited because of unpredictable fetal motion, and such tools have also been inadequately validated in high-risk populations other than those with congenital diaphragmatic hernia. The advent of advanced, functional magnetic resonance imaging techniques such as diffusion and T2* imaging, and the development of postprocessing pipelines that facilitate motion correction, have enabled not only more accurate evaluation of pulmonary size, but also assessment of tissue microstructure and perfusion. In the future, fetal magnetic resonance imaging may have an increasing role in the prognostication of pulmonary abnormalities and in monitoring current and future antenatal therapies to enhance lung development. This review aims to examine the current imaging methods available for assessment of antenatal lung development and to outline possible future directions.
Prenatal prediction of pulmonary hypoplasia
2017, Seminars in Fetal and Neonatal Medicine
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The most frequent are thoracic circumference (TC), thoracic circumference:abdominal circumference ratio (TC:AC), and lung area (LA). These measurements are taken in an axial plane at the level of the four-chamber view of the heart (Fig. 2) [14–16]. TC and LA are gestational-age dependent, whereas the ratio TC:AC does not vary by gestational age [15,17].
Pulmonary hypoplasia, although rare, is associated with significant neonatal morbidity and mortality. Conditions associated with pulmonary hypoplasia include those which limit normal thoracic capacity or movement, including skeletal dysplasias and abdominal wall defects; those with mass effect, including congenital diaphragmatic hernia and pleural effusions; and those with decreased amniotic fluid, including preterm, premature rupture of membranes, and genitourinary anomalies. The ability to predict severe pulmonary hypoplasia prenatally aids in family counseling, as well as obstetric and neonatal management. The objective of this review is to outline the imaging techniques that are widely used prenatally to assess pulmonary hypoplasia and to discuss the limitations of these methods.
Prediction of lethal pulmonary hypoplasia among high-risk fetuses via 2D and 3D ultrasonography
2013, International Journal of Gynecology and Obstetrics
Citation Excerpt :
AFI was analyzed according to normal reference curves [16], and TC values were analyzed according to normal reference curves [2]. TC/AC and TA/HA were analyzed according to normal reference curves [14]. Three fetal chest volume measurements were acquired, preferably when the fetus was facing toward the transducer and motionless.
To compare accuracy between 3D and 2D ultrasonography for predicting lethal pulmonary hypoplasia (LPH) among high-risk fetuses.
In a cross-sectional prospective study at a fetal medicine referral center in Brazil, bilateral fetal lung scans were evaluated for 54 fetuses with suspected LPH between May 2008 and June 2011. Measurements for predicting LPH were ultrasonographic fetal lung volume/estimated fetal weight ratio (US-FLW), observed/expected thoracic circumference (o/e-TC), observed/expected thoracic circumference/abdominal circumference (o/e-TC/AC), observed/expected thoracic area/heart area (o/e-TA/HA), observed/expected amniotic fluid index (o/e-AFI), and observed/expected total fetal lung volume (o/e-Tot-FLV). To evaluate accuracy in predicting LPH, receiver operating characteristic (ROC) curves were calculated, and areas under the curves (AUCs) were compared. The intraclass correlation coefficient (ICC) was used to assess 3D lung volume reproducibility.
Data were compared for 47 newborns, of whom 34 had LPH (perinatal mortality 74.5%). The AUCs for predicting LPH were 0.93, 0.69, 0.55, 0.46, 0.71, and 0.86 for US-FLW, o/e-TC, o/e-TC/AC, o/e-TA/HA, o/e–AFI, and o/e-Tot–FLV, respectively. No significant intraobserver difference was observed in measurements of the right (ICC, 0.973; P < 0.0001) or left (ICC, 0.950; P < 0.0001) lung volumes.
Among high-risk fetuses, US-FLW by 2D/3D and o/e-Tot-FLV by 3D ultrasonography were more accurate than 2D parameters for predicting LPH.
The management of preterm premature rupture of the membranes near the limit of fetal viability
2009, American Journal of Obstetrics and Gynecology
Citation Excerpt :
Some authors have attempted to correct for overall fetal size by including another fetal parameter such as femur length, heart area, or abdominal circumference. Table 8 presents results from studies that evaluated the predictive value of ultrasound for lethal pulmonary hypoplasia.29,31-35 All of these studies were performed in patients at risk for pulmonary hypoplasia, including patients with PROM.
Preterm premature rupture of the membranes near the limit of fetal viability is an uncommon complication of pregnancy, affecting approximately 4 in 1000 gravidas. However, maternal, fetal, and neonatal complications resulting from this condition are significant and include chorioamnionitis, pulmonary hypoplasia, restriction deformities, fetal loss, and complications of extreme prematurity among surviving infants. In this article, we review the literature regarding pregnancy outcomes after preterm premature rupture of the membranes near the limit of viability, and the data on traditional and nontraditional interventions to improve outcomes. An approach to patients who present with preterm premature rupture of the membranes near the limit of viability will be proposed.
Predicting pulmonary hypoplasia with 2- or 3-dimensional ultrasonography in complicated pregnancies
2008, American Journal of Obstetrics and Gynecology
Citation Excerpt :
For 2D measurements, freeze-frame capabilities were available and on-screen calipers were used. Abdominal circumference (AC), FL, and other routine biometry were measured according to the technique described by Hadlock et al.14 The bony TC, TA, and HA were determined from a cross-section of the fetal thorax at the 4-chamber view level with the heart in ventricular diastole.6-8 From this view, circumferences and areas were automatically calculated.
The aim of this study was to compare 3-dimensional (3D) lung volume measurements with 2-dimensional (2D) biometric parameters in predicting pulmonary hypoplasia in complicated pregnancies.
In this prospective study, 1-4 scans of the fetal lungs were obtained in 33 pregnancies complicated by various disorders or complications with regard to pulmonary hypoplasia. The 3D lung volumes vs gestational age or estimated fetal weight, the thoracic circumference vs gestational age or femur length, the thoracic/abdominal circumference ratio, and the thoracic/heart area ratio were measured.
Of the 33 infants, 16 (48.5 %) were diagnosed with pulmonary hypoplasia on postmortem examination or the clinical and radiological presentation. Three dimensional lung volume measurements had a better diagnostic accuracy for predicting pulmonary hypoplasia (sensitivity, 94%; specificity, 82%; positive predictive value [PPV], 83%; negative predictive value [NPV], 93%), compared with the best 2D biometric measurement thoracic/heart area ratio (sensitivity, 94%; specificity, 47%; PPV, 63%; NPV, 89%).
3D lung volume measurements seem to be useful in predicting pulmonary hypoplasia prenatally.
Prenatal diagnosis in the second trimester of asphyxiating thoracic dysplasia
2007, Progresos en Obstetricia y Ginecologia
Describimos un caso de diagnóstico prenatal de síndrome de Jeune. Debido a su baja incidencia, es excepcional realizar el diagnóstico de este síndrome a las 21 semanas de gestación en una paciente de riesgo bajo. La displasia torácica asfixiante o síndrome de Jeune es una displasia esquelética hereditaria de carácter autosómico recesivo. El diagnóstico prenatal se puede realizar por ecografía; este síndrome se caracteriza por tórax pequeño, costillas cortas, anormalidades pélvicas, braquimelia rizomélica, y anomalías renales y hepáticas, entre otras. En nuestro caso, el diagnóstico prenatal fue confirmado con la necropsia.
A case of prenatal diagnosis of Jeune’s syndrome is described. Because the incidence of this syndrome is low, diagnosis in the 21st week of pregnancy is exceptional. Jeune’s syndrome, or asphyxiating thoracic dysplasia, is a skeletal dysplasia with autosomal recessive inheritance. Prenatal diagnosis can be established by ultrasonographic findings of a small thorax, short ribs, pelvic abnormalities, rhizomelic brachymelia, and renal and liver anomalies, among others. In the present case, the prenatal diagnosis was confirmed at necropsy.

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: Presented at the Ninth Annual Meeting of the Society of Perinatal Obstetricians, New Orleans, Louisiana, February 2-4, 1989.

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Comparison of six different ultrasonographic methods for predicting lethal fetal pulmonary hypoplasia

Abstract

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

The lung in congenital bilateral renal agenesis and dysplasia

Arch Dis Child