OP28.05: Pleuro-amniotic shunting in bronchopulmonary sequestration with fetal hydrops-outcome in three cases depending on gestational age on birth and size of the lesion

The patient was a 29-year multiparous woman, hospitalised in the 25 week of pregnancy because of fetal hydrops (ascites, polyhydramnios, placentomegaly) and cardiomegaly. The results of the physical and laboratory examinations of the mother were initially normal. MCA PSV in the fetus was 1.9 MoM. Diagnostic cordocentesis revealed profound fetal anemia with high erytroblastosis, thrombocytopenia and fetal PVB19 viremia (2.27 × 108 IU/ml). We transfused to the fetal umbilical vein 35 ml of packed red cells and 0.5 g IVIG. After the transfusion the MCA PSV normalised. In the fourth day after the transfusion the patient reported dyspnoea, oedema of lower extremities and rash on the palmar side of her hands. There was fluid in both pleural cavities. The fluid balance was positive (plus 9 kg in one week), the blood pressure was normal all the time, but the condition of the mother was deteriorating rapidly. The blood parameters showed surprisingly progressive hemodilution and the patient was gradually developing anemia and thrombocytopenia, with elevation of aminotransferases. In the next few days we observed dyspnoea at rest, continuous liver pain and enlargement and massive generalised oedema. The patient was given high doses of diuretics (i.v. furosemide up to 60 mg a day), antibiotics, steroids, IVIG (0.5 g/day) and FFP. After about one week of treatment the condition of the fetus and the mother started to improve and the oedema in both patients gradually disappeared. In the 30 week of pregnancy the patient left the hospital. There was PROM and premature delivery in the 31 week of pregnancy. She delivered a child 1750/45 g with minor ascites, but no important medical problems.