Many factors influence decisions about which fetal therapy to pursue for a baby with CPAM, if any. These include the size and number of lesions, whether the lesions are solid or filled with fluid, and whether hydrops or mirror syndrome has developed.
When the lesions are solid or are growing too quickly, our team may recommend steroid treatment as a first step. Steroids can slow the growth of the lesions, possibly allowing patients to avoid fetal surgery.
When large, fluid-filled cysts are present, the medical team may recommend draining them using thoracentesis. This involves inserting a needle through the womb into the lesion and draining the fluid. To prevent future fluid build-up, the surgeon may place a thoracoamniotic shunt, or catheter, to continue draining fluid from the lesion into the amniotic cavity.
If large, solid lesions are present and severe hydrops has developed, the team may recommend open fetal surgery to remove the lesions. Following surgery, ultrasound examinations are performed to monitor the baby’s condition. These babies are usually delivered by Cesarean section, if fetal surgery was required, and their prognosis is excellent after surviving fetal surgery − very few need breathing assistance after delivery.
If mirror syndrome has occurred, our team will recommend early delivery to protect the life of the mother. Otherwise, we try to avoid early delivery as a more mature baby will tolerate newborn care with greater ease and fewer complications.