Multiple Gestations Do Not Worsen Outcomes in Fetal Lung Lesions

Published on in CHOP News

Fetal medicine experts at The Children's Hospital of Philadelphia (CHOP) report that among multiple gestations (twins or triplets) in which one fetus is diagnosed before birth with a lung lesion, outcomes are similar to those for single-gestation fetuses with lung lesions. In addition, this new study suggests that these outcomes may be better than those seen for other birth defects that complicate multiple pregnancies.

Fetal lung lesions occur in a variety of subtypes, with some remaining small or shrinking before birth, and others enlarging rapidly, with potentially life-threatening consequences. A team from CHOP’s Center for Fetal Diagnosis and Treatment analyzed all fetal lung lesion cases evaluated at the center between 1996 and 2012. Of all 960 cases, 30 involved multiple gestations—28 sets of twins and two sets of triplets. The mortality rate was 3 out of 30 (10 percent) for affected fetuses, with no deaths or morbidity for co-twins at or after 36 weeks of gestation.

N. Scott Adzick, MD, Surgeon-in-Chief at CHOP and director of the Center for Fetal Diagnosis and Treatment, led this case-series study, which was published online Nov. 5, 2014 in Fetal Diagnosis and Therapy.

“Because the outcomes of multigestational pregnancies complicated by a fetal lung lesion have not been previously reported, we reviewed our experience with such patients in order to guide counseling for families facing this uncommon circumstance,” said Dr. Adzick.

He added that the outcome of the pregnancy is likely to depend on the gestational age at delivery, independent of the fact that the mother is carrying multiples.

The study team concluded that the severity of the lesion is key to the outcome for the affected fetus, and that prolonging the gestation to at least 36 weeks offers the best outcome for a normal co-twin.

For more information

Vrecenak JD, Howell, LJ, Khalek N, Moldenhauer JS, Johnson MP, Coleman BG, Victoria T, Hedrick HL, Peranteau WH, Flake AW, Adzick NS. Outcomes of Prenatally Diagnosed Lung Lesions in Multigestational Pregnancies. Fetal Diagnosis and Therapy, published online, Nov. 5, 2014.