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Fetal intervention is offered only in cases when the fetus develops hydrops or impending hydrops. This can be monitored closely on ultrasound. Signs of hydrops in the fetus include ascites (fluid in the abdomen), edema (extra fluid) of the skin and scalp and pleural or pericardial effusion (fluid around the heart and lungs).
Doctors will be paying close attention to the mother's health status. As the fetus develops hydrops, the mother can mirror the signs and symptoms with preeclampsia (high blood pressure and protein in the urine.) If the hydrops gets too severe and the mother is very ill, doctors may not be able to perform surgery.
If hydrops is imminent or the fetus develops hydrops and it isn't too severe, prenatal intervention will be offered sometime prior to 28 weeks gestation. The procedure involved depends on the type of CCAM. If the mass is cystic in appearance, then it usually can be drained percutaneously (with a needle and a drain). If the fluid reaccumulates, a shunt can be placed to continuously drain the cyst.
Sometimes the mass needs to be removed during open fetal surgery, when it is solid and sometimes even when it is cystic. This procedure usually occurs prior to 28 weeks of pregnancy. In this case, the mother is placed under general anesthesia, the uterus is surgically opened, the fetus is partially taken out of the uterus and the mass is removed. The fetus is returned to the uterus, which is then closed, and the mother and fetus are monitored closely after the procedure. There is a risk for preterm labor when an incision is made in the uterus, but medications are given to help control the contractions. For more information, see Fetal Surgery.
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