Natural history and perinatal outcomes of antenatally diagnosed CPAM in a resource‐limited setting

Abstract

Abstract Objective To evaluate the antenatal natural history, prognostic factors, and perinatal outcomes of fetuses diagnosed with congenital pulmonary airway malformation (CPAM) in a resource‐limited tertiary fetal medicine setting. Methods This single‐center retrospective observational case series included 22 fetuses diagnosed with CPAM between 2018 and 2025 at a tertiary fetal medicine unit. Clinical, sonographic, and postnatal outcome data were obtained from electronic medical records and parental follow‐up. Lesions were categorized based on sonographic morphology, and serial congenital pulmonary airway malformation volume ratio (CVR) measurements were assessed to evaluate antenatal progression and prognostic correlation. Results Among 12 058 anomaly scans conducted during the study period, 22 fetuses were diagnosed with CPAM, giving a prevalence of 0.18%. Microcystic CPAM was the predominant subtype (15/22, 68%). Spontaneous regression occurred in 5/22 (22.7%) cases, while 8/22 (36.4%) demonstrated lesion plateauing, resulting in an overall regression/plateau rate of 59.1%. A CVR >1.6 was observed in two fetuses; one developed hydrops followed by intrauterine demise, while the other resulted in a live birth. Among the 22 antenatally diagnosed fetuses, outcomes included two terminations of pregnancy, one intrauterine demise and 19 live births. Immediate postnatal outcome data were available for 17/19 neonates: 3/17 (17.6%) had respiratory distress, while 14/17 (82.4%) were asymptomatic at birth. Postnatal imaging was available in 17/19 (89.5%) liveborn neonates and demonstrated persistent lesions in 9/17 (52.9%) and apparent complete resolution in 7/17 (41.2%). Overall, five neonates underwent lobectomy, all with favorable outcomes. Conclusion Most antenatally diagnosed isolated CPAMs demonstrated a benign natural history with favorable perinatal outcomes. These findings support conservative management in carefully selected non‐hydropic fetuses; however, larger prospective studies with standardized postnatal imaging are required.