First Experience in Pleural-Amnion Grafting

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

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


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


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


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


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


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


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


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


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


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


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

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