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Fetus

Poster Session 3

(651) Lung size and Doppler velocimetry after serial amnioinfusions in fetuses with renal agenesis/dysplastic kidneys

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Edgar Hernandez Andrade, MD, PhD (he/him/his)

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

    • Coauthor(s)

  • Eric P. Bergh, MD

    Assistant Professor
    McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
    Houston, TX, United States

  • Ramesha Papanna, MD, MPH

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • Jimmy Espinoza, MD, MSc (he/him/his)

    Professor
    McGovern Medical School at the University of Texas Health Science Center Houston, The Fetal Center- Children’s Memorial Hermann Hospital
    Houston, TX, United States

  • SL

    Suzanne Lopez, MD

    Neonatal Perinatal Medicine Specialist
    McGovern Medical School at The University of Texas, Health Science Center at Houston
    Houston, TX, United States

  • PP

    Percy Pacora, MD

    Associate Professor
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • Anthony Johnson, DO

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

Objective: To evaluate changes in fetal lung size/volume and intrapulmonary (IP) circulation after serial amnioinfusions (AI) in fetuses with bilateral renal agenesis/dysplasia and anhydramnios.

Study Design: Seven fetuses with anhydramnios due to renal agenesis (n=4) or renal dysplasia (n=3) were managed with serial AI. Each AI targeted an AFI 15-17 cm and was repeated when AFI fell to 5-8 cm until the decision of delivery or PPROM occurred. Lungs size was measured before each AI via observed/expected lung-to-head (O/E LHR) and cardiothoracic ratios (CTR). Pulsatility index (PI) of the IP artery was also obtained. Expectation was to achieve O/E LHR 100% with 5th and 95th  percentiles 67% and 133%. CTR, IP-IP values were plotted against reference standards.

Results: No intrauterine deaths; 105 total (Median/case 16: range 11-21) AIs were performed between 17-32 weeks. PPROM occurred in one fetus at 28 weeks and in all others >31 weeks of gestation. All fetuses were born ≥32 weeks; 3/7 newborns (42.9%) survived and were discharged on dialysis until renal transplant. At first AI, all fetuses had low O/E LHR in both lungs (average left 64.2% [11.4]; right 61.4% [13.5]), which improved with repeated AI; however, the left O/E LHR was  < 100% in 93.8% of subsequent AIs and < 5th percentile in 37.5% of measurements, and the right O/E LHR was < 100% in, 99% of measurements and < 5th percentile in 53.3% of subsequent AIs. CTR reduced after first AI but remained >90th percentile in 75% (89/120) of the evaluations (Fig. 1). Four fetuses had high IP-PI ( >95th percentile) before first AI, which normalized after the second; in two fetuses, IP-PI increased >95th percentile after PPROM. Survivors had larger LHR and lower CTR than non-survivors (O/E LHR left 78.2 vs. 72.05%; right 71.4 vs 63.5%; CTR 0.56 vs. 0.58, respectively).  

Conclusion: Fetal lung size increased after AI but remained below the expected mean for gestational age. Anhydramnios with severe thoracic compression in the second trimester of pregnancy may reduce lung plasticity, limiting growth potential