ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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First Experience in Pleural-Amnion Grafting

DOI:10.31550/1727-2378-2021-20-1-38-44
For citation: Kosovtsova N.V., Bashmakova N.V., Sytykh O.N., Grishkina A.A. First Experience in Pleural-Amnion Grafting. Doctor.Ru. 2021; 20(1): 38–44. (in Russian). DOI: 10.31550/1727-2378-2021-20-1-38-44
12 March 00:00

Study Objective: To analyse our own experience in pleural-amnion grafting for nonimmune hydrops fetalis with significant pleural effusion and to compare it with the experience of our foreign colleagues.

Study Design: retrospective study.

Materials and Methods. In 2019-2020, in Ural Scientific and Research Institute of Mother and Child Protection (Ekaterinburg) we had 6 cases of antenatal foetal antenatal hydrothorax, where we used pleural-amnion grafting. In 5 (83.3%) cases we diagnosed nonimmune hydrops fetalis with bilateral hydrothorax; only in 1 (16.7%) case, hydrothorax was one-sided and did not develop into nonimmune hydrops fetalis (possible aetiology: recent COVID-19 infection in mother). All pregnant women underwent complete clinical and lab examination and foetus condition assessment; a paediatric surgeon was consulted; further obstetrician methods were discussed by a board of medical professional; and pleural-amnion grafting was recommended in order to prevent lethal foetal pulmonary hypoplasia. Each patient underwent cordocentesis, one-sided pleural-amnion grafting with a graft developed in Ural Scientific and Research Institute of Mother and Child Protection.

Study Results. Once one pleural cavity was drained, we recorded clinical improvements in 3 (60%) cases in foetuses with nonimmune hydrops fetalis. Two patients had urgent delivery with caesarean section. Their babies had marked respiratory distress and stayed in ICU for a long time. One newborn had the graft removed immediately after birth, the other remained with the functioning graft for 7 days to drain the pleural cavity. At the moment, the children are undergoing rehabilitation. In one case, all signs of nonimmune hydrops fetalis disappeared in 14 days post grafting; the graft was removed immediately after birth. The child was discharged on day 4.

2 (40%) foetuses with nonimmune hydrops fetalis had graft expulsion within 3 days post grafting; premature abdominal birth was performed for the benefit of the child. The newborns died in ICU on day 1 and day 2, respectively. In one-sided hydrothorax, the foetus had graft expulsion to the amniotic cavity on day 5 post surgery, after that the foetus had significant pleural effusion and mediastinal organs displacement, therefore the pregnant woman underwent caesarean section. The child died on day 2 in ICU.

Conclusion. Use of the graft made in Russia allowed minimally invasive surgery for antenatal pleural-amnion grafting. The efficiency of pleural-amnion grafting used by Ural Scientific and Research Institute of Mother and Child Protection was 50%; it is significantly lower than the cumulative survival described in publications (65.7%). In 50% of cases, the only complication was graft expulsion because of inadequate graft attachment in pleural cavity. The method requires refining as regards graft placement and structural improvements.

Contributions: Kosovtsova, N.V. — study concept and design, information collection and preparation, manuscript editing, cohesion of all parts of the article; Bashmakova, N.V. — manuscript editing, approval of the final article version; Sytykh, O.N. — statistical processing of information, information systematisation, manuscript preparation; Grishkina, A.A. — post-mortem examinations, histology.

Conflict of interest: The authors declare that they do not have any conflict of interests.

N.V. Kosovtsova (Corresponding author) — Ural Scientific and Research Institute of Mother and Child Protection of the Ministry of Health of the Russian Federation; 1 Repin St., Ekaterinburg Russian Federation 620028. https://orcid.org/0000-0002-4670-798X. E-mail: kosovcovan@mail.ru

N.V. Bashmakova — Ural Scientific and Research Institute of Mother and Child Protection of the Ministry of Health of the Russian Federation; 1 Repin St., Ekaterinburg Russian Federation 620028. https://orcid.org/0000-0002-8091-9863. E-mail: bashmakovanv@niiomm.ru

O.N. Sytykh — Ural Scientific and Research Institute of Mother and Child Protection of the Ministry of Health of the Russian Federation; 1 Repin St., Ekaterinburg Russian Federation 620028. E-mail: osytykh@gmail.com

A.A. Grishkina — Ural Scientific and Research Institute of Mother and Child Protection of the Ministry of Health of the Russian Federation; 1 Repin St., Ekaterinburg Russian Federation 620028. E-mail: xumukuc@mail.ru

Доктор.ру

Fig. 1. Lethal pulmonary hypoplasia in a foetus with nonimmune hydrops fetalis. Gestational age: 32–33 weeks. Image courtesy of N.V. Kosovtsova

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Fig. 2. Pulmonary hypoplasia. Slides. Image courtesy of A.A. Grishkina

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Fig. 3. Ultrasound presentation of bilateral foetal hydrothorax. Image courtesy of N.V. Kosovtsova

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Fig. 4. No lung blood flow in directional power doppler mode, antenatal foetal hydrothorax. Image courtesy of N.V. Kosovtsova

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Fig. 5. Pig tail arrangement in pleural-amnion grafting. Image courtesy of N.V. Kosovtsova

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Fig. 6. Graft used for drainage after birth. Image courtesy of O.N. Sytykh

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Fig. 7. Graft placed on week 32 of pregnancy. Image courtesy of N.V. Kosovtsova

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Fig. 8. Newborn with a pleural-amnion graft after birth. Image courtesy of N.V. Kosovtsova

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Table
Reasons and time frames for pleural-amnion grafting, delivery time, outcomes, and complications described in foreign publications in 2010-2018 [11, 20, 24–29]

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Note: NIHF: nonimmune hydrops fetalis; PAG: pleural-amnion grafting; GD: graft displacement; CA: chorioamnionitis; NA: not available.

Received: 18.01.2021
Accepted: 12.02.2021

12 March 00:00
LITERATURE
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