What are the treatment options for a baby with a CPAM who develops hydrops?

(calm chime) – A small number of fetuses who have really giant lung
masses may develop hydrops. The mass can push on the heart and the blood vessels leading to the heart and essentially cause heart failure and hydrops in the fetus. And we know this is a
very dangerous situation for the fetus. We’ve learned over the last several years that we can predict which fetuses are at risk for developing hydrops. And some new information
indicates that giving the mother steroids can either prevent
hydrops from developing in babies with large CTAMs. Or if they have some hydrops it can improve the
outcome for those babies. So our first line of treatment is usually giving maternal steroids if there’s a very large lung mass or there’s early development of hydrops. If that doesn’t reverse the course of the hydrops for that baby, then we would offer open fetal surgery if it’s a solid mass. If the mass happens to
have a very large cyst, sometimes a thoracal amniotic shunt can be placed into the cyst to decompress and reduce the overall size of the mass. But for large solid lesions that don’t respond to maternal steroids the only available option
is open fetal surgery in the middle of pregnancy
to remove the mass.

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