Imagiological methods for prediction of fetal pulmonary hypoplasia: a systematic review

Abstract

Objective

To compare the different imagiological methods for prediction of fetal pulmonary hypoplasia (PH) in general diseases and associated with preterm rupture of membranes (PROM), and congenital diaphragmatic hernia (CDH).

Methods

According to PRISMA guidelines, all the literature on PH from 1988 to 2018 was reviewed. Twenty-nine articles were selected and analyzed for two- and three- dimensional-ultrasounds (2D and 3D-US) as predictors for the lethal outcome.

Results

Overall, the results identify a general gap correlating prenatal pulmonary measurements and survival at birth; discrepant predictive values for the same imagiological methods are explained by the group heterogeneity in terms of diseases and degree of severity, with the 2D measurements being more affected than 3D; 2D and 3D-US present equally predictive values for groups with 0% of survival. Regarding PROM, results demonstrate comparable accuracies for similar survival rates suggesting a useful predictive value of 2D-US in outcome estimation; they also identify ultrasonographic methods as a more accurate prognostic factor than gestational age at rupture, latency or amniotic fluid index. In CDH, consistent with previous studies, our review shows magnetic resonance imaging as a better survival predictor followed by the 3D and 2D methods, while 2D-LHR was the more precise prognosticator correlating prenatal PH, survival at birth, and the need for neonatal respiratory support.

Conclusion

Ultrasonographic methods can be valuable predictors for lethal PH and should be validated for a broad set of diseases (e.g. PROM). For that, restricted studies for disease groups and correlating fetal PH with the needed of neonatal support, and survival at birth is critically recommended.

Keywords:

• CDH
• PROM
• pulmonary hypoplasia
• systematic review
• ultrasonography

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the European Regional Development Fund (ERDF), through the Operational Programme for Competitiveness and Internationalisation (COMPETE 2020), under Portugal 2020, and by Fundação para a Ciência e a Tecnologia (FCT) through national funds, under de project POCI-01–0145-FEDER-030881; Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER) under the scope of the project NORTE-01–0246-FEDER-000012; Gonçalves was supported by FCT (reference PD/BDE/127829/2016).