Outcome of fetal cystic hygroma and experience of intrauterine treatment

Objective: To review our cases of fetal cystic hygroma and to examine the p rognostic factors with the goal of establishing criteria for the intrauteri ne treatment for cystic hygroma. Patients and Methods: Thirty-one cases of fetal cystic hygroma were managed by us from January 1988 to December 1997, and 21 cases were available for analysis. Three prognostic factors, namely chromosomal abnormality, structural anomaly and hydrops feta lis, were eva luated. We treated 2 cases of cystic hygroma associated with hydrops feta l is in utero using OK-432 injection under ultrasound guidance. Results: The fetuses without any of the prognostic factors listed above showed a good pr ognosis throughout the fetal and neonatal periods. However, in this group, 2 infants with large tumors died of hemorrhage from the tumor at 6 months a nd 3 years of age, respectively. Cases with hydrops fetalis without chromos omal abnormalities or structural anomalies (5 cases) resulted in either int rauterine fetal death (IUFD, 2 cases) or early perinatal neonatal death (ea rly PND, 3 cases). The cause of early PND was circulatory failure. Most of the hydrops cases with either a chromosomal abnormality or structural anoma ly resulted in IUFD before 22 weeks of gestation. The size of the cyst decr eased in 1 of 2 cases treated in utero. Conclusions: The fetal cases of cys tic hygroma showing hydrops fetalis without chromosomal abnormalities or st ructural anomalies are considered to be possible candidates for intrauterin e therapy. Those with very large cystic hygroma without any of the three pr ognostic factors are also thought to be candidates for fetal treatment. Bas ed on our clinical experience, sclerotherapy using OK-432 is considered to be a treatment option in selected cases with fetal cystic hygroma. Copyrigh t (C) 2001 S. Karger AG, Basel.