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

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.