P27.12: Identifying fetuses at risk of pulmonary hypoplasia with three dimensional ultrasonography and role of amnioinfusion in the management

The most serious complication of preterm premature rupture of membranes (pPROM) with associated oligohydramnios is pulmonary hypoplasia, occurses in 9–28% of the cases. The prediction of the risk of pulmonary hypoplasia may have a substantial impact on prenatal management. Measuring fetal lung volume could be useful in prognosis evaluation. Recent studies have suggested that 3D sonography could also be a reliable method to determine fetal lung volumes prenatally. The aim of this study was to determine fetal lung volume to identify the patients who may benefit by amnioinfusion. Fetal lung volume was measured using 3D VOCAL in 28 patients with pPROM complicated by oligohydramnios at a mean 25 weeks gestation. All fetuses had a lung volume ranging between the 5 and the 10 centile. 14 patients underwent serial amnioinfusions (group A) while the others were managed expectantly (group B). The percentage of lung hypoplasia at birth in the two groups were compared. At birth there were 2 cases with pulmonary hypoplasia in group A and 10 in group B. The prevalence of pulmonary hypoplasia was significantly lower among the amnioinfused cases (14.28%) compared with the control group (71.42%) (P < 0.05). 3D lung volume measurements seem to be able to identify fetuses at risk for pulmonary hypoplasia and serial amnioinfusions appear to offer a favourable perinatal outcome in fetuses with a lung volume ranging between the 5 and the 10 at the 3D ultrasonography scan.