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Vol. 20, No. 4, 2005
Issue release date: July–August 2005
Section title: Paper
Fetal Diagn Ther 2005;20:309–315
(DOI:10.1159/000085092)

Antenatal Treatment of Chylothorax and Cystic Hygroma with OK-432 in Nonimmune Hydrops fetalis

Chen M.a-c · Chen C.-P.d · Shih J.-C.b · Chou H.-C.e · Yu C.-L.a · Wang B.-T.c · Hsieh C.-Y.b
Departments of aMedical Genetics, bObstetrics and Gynecology, National Taiwan University Hospital, Taipei; cDepartment of Obstetrics and Gynecology and Center for Medical Genetics, Changhua Christian Hospital, Changhua; dDepartment of Obstetrics and Gynecology, Mackay Memorial Hospital, and eDepartment of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan

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Article / Publication Details

First-Page Preview
Abstract of Paper

Received: 7/22/2004
Accepted: 9/28/2004
Published online: 6/16/2005
Issue release date: July–August 2005

Number of Print Pages: 7
Number of Figures: 4
Number of Tables: 2

ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT

Abstract

Objectives: To present our experience of using OK-432 in treating fetal cystic hygroma and chylothorax complicated with nonimmune hydrops fetalis. Methods: OK-432 (Picibanil®) was injected into the fetal pleural cavity or fetal cystic hygroma. Results:Patient 1: A 23-year-old, gravida 2, para 1, was found to have a recurrent fetal chylothorax at GA 29 weeks. Serial amnioreduction and thoracocentesis was performed at GA 31, 32, 33, and 34 weeks. Intrapleural OK-432 injection was performed twice at GA 33 and 34 weeks. Cyanosis and respiratory distress were noted immediately after birth (GA 34 weeks). The baby expired despite of aggressive neonatal resuscitation. Patient 2: A 26-year-old, gravida 2, para 1, was found to have a cystic hygroma of her fetus at GA 17 weeks. Karyotype of the cystic fluid and the amniocytes were 46, XY. Fetal ascites developed at GA 22 weeks. OK-432 injection into the tumour was performed at GA 23 weeks. Stabilization of the cystic hygroma was noted throughout the pregnancy (about 3.5 cm in diameter). Serial fetal paracentesis and/or amnioreduction were performed. Karyotype of the ascites was again 46, XY. Maternal dietary modification with medium chain triglyceride was also prescribed. Chylothorax developed and the baby was born by cesareans at GA 32 weeks. Resolution of pleural effusion, ascites, and regression of cystic hygroma were noted since the 2nd day after birth. The baby had survived beyond 4 months of age at submission. Conclusion: Combination of antenatal OK-432 injection, maternal dietary modification, serial thoracocentesis plus paracentesis, together with amnioreduction and tocolysis, appeared to contribute to the success of antenatal treatment. Fetal pulmonary expansion may determine the immediate neonatal survival.

© 2005 S. Karger AG, Basel


  

Author Contacts

Dr. Ming Chen, MD, MSc (Med Sci)
Center for Medical Genetics, Changhua Christian Hospital
176, Chung Hua Road
Changhua 500 (Taiwan)
Tel. +886 4 7225121, ext 2323, Fax +886 4 7249847, E-Mail mchen_cch@yahoo.com

  

Article Information

M.C. & C.-P.C. contributed equally to this study.

Received: July 22, 2004
Accepted after revision: September 28, 2004
Number of Print Pages : 7
Number of Figures : 4, Number of Tables : 2, Number of References : 20

  

Publication Details

Fetal Diagnosis and Therapy (Clinical Advances and Basic Research)

Vol. 20, No. 4, Year 2005 (Cover Date: July-August 2005)

Journal Editor: Holzgreve, W. (Basel)
ISSN: 1015–3837 (print), 1421–9964 (Online)

For additional information: http://www.karger.com/fdt


Article / Publication Details

First-Page Preview
Abstract of Paper

Received: 7/22/2004
Accepted: 9/28/2004
Published online: 6/16/2005
Issue release date: July–August 2005

Number of Print Pages: 7
Number of Figures: 4
Number of Tables: 2

ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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