Evaluation of pulmonary hypoplasia in various congenital anomalies with a comparison of two conventional methods of assessment: radial alveolar count (rac) and lung weight: body weight ratio (lbw)

Abstract

Objective: Pulmonary hypoplasia is common in the perinatal period and causes death in newborn infants. It is commonly associated with a number of malformation syndromes. Various parameters are used to estimate pulmonary hypoplasia at fetal autopsy including Lung Weight Body Weight ratio (LW:BW), Radial Alveolar Count (RAC) and DNA estimation. Material and Method: This study was carried out as a retrospective analysis of 108 lung specimens of fetuses with congenital anomalies for a period of five years. All terminated fetuses with anomalies were received with 10% formalin. An inverted Y-shaped incision was made on the fetus to remove the lungs. Lung weight and body weight were measured and the ratio was calculated. Morphometric estimation of RAC was done microscopically by counting the number of alveoli using the Q capture software. RAC was calculated based on gestational age. Results: Among the restrictive lung diseases, pulmonary hypoplasia by the LW:BW ratio was prevalent in 43% while the same by RAC was 19%. Similarly, pulmonary hypoplasia by the LW:BW ratio was prevalent in 35% while the same by RAC was 26% among cases with non restrictive lung diseases. Oligohydramnios showed the highest prevalence of pulmonary hypoplasia (23.7%), followed by renal anomalies (16.9%) and CNS anomalies (15.2%). Conclusion: Pulmonary hypoplasia is a common occurrence in many congenital anomalies, premature rupture of membranes, and hydrops fetalis. Identifying the anomaly during the intrauterine period will help to anticipate and accordingly manage the baby in the postpartum period. Early diagnosis of correctable condition like oligohydramnios will also help in the early intervention and prevention of pulmonary hypoplasia.

Evaluation of relative frequency of pulmonary hypoplasia and various anomalies associated with pulmonary hypoplasia in fetal autopsy study

“…In studies done by Aghabiklooei et al ( 1 ), Wigglesworth and Desai ( 11 ), Husain and Hessel ( 6 ) and Cherian et al ( 10 ), PH was noted in 11.3%, 14.5%, 26%, and 43% respectively. In the present study, PH was noted in 72.58%.…”

“…The frequency of meconium aspiration increased as the GA advanced. (10), PH was noted in 11.3%, 14.5%, 26%, and 43% respectively. In the present study, PH was noted in 72.58%.…”

“…In study done by Cherian et al ( 10 ), PH was noted in more than 10% of neonatal autopsies and they also mentioned that more than 85% of cases PH occur in association with other conditions/malformations. In the present study, out of 62 cases of fetal autopsy PH was noted in 45 cases amounting to 72.58% of cases.…”

“…*: Statistically significant (p value <0.05) LW: Lung weight, BW: Body weight, RAC: Radial alveolar count, IUD: Intrauterine death, CCAM: Congenital cystic adenomatoid malformation, PROM: Premature rupture of membranes, CDH: Congenital diaphragmatic hernia, AMC: Arthrogryposis multiplex congenitaIn study done by Cherian et al(10), PH was noted in more than 10% of neonatal autopsies and they also mentioned that more than 85% of cases PH occur in association with other conditions/malformations. In the present study, out of 62 cases of fetal autopsy PH was noted in 45 cases amounting to 72.58% of cases.In studies done by Aghabiklooei et al (1), Wigglesworth and Desai (11), Husain and Hessel (6) and Cherian et al…”