How do we counsel patients carrying a fetus with pleural effusions?

Santolaya-Forgas, Joaquín

doi:10.1046/j.0960-7692.2001.00553.x

Cited by 9 publications

(7 citation statements)

References 26 publications

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“…A primary PE occurs in approximately 1 in 12,000 pregnancies with a 2:1 male:female ratio. Gestational age !32 weeks and the presence of hydrops are associated with a high perinatal mortality, ranging from 36 to 46% [5][6][7][8]. Gender of the fetus, polyhydramnios, extent of effusions, and mode of delivery are not significantly related to the outcome [5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

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Thoracoamniotic Shunts: Fetal Treatment of Pleural Effusions and Congenital Cystic Adenomatoid Malformations

et al. 2004

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Objective: To determine whether fetuses that underwent thoracoamniotic shunt placement for treatment of pleural effusion (PE) or macrocystic congenital cystic adenomatoid malformation (CCAM) have an improved outcome as compared with an untreated population. Methods: A retrospective review from a single tertiary center was performed using thoracoamniotic shunt placement to treat PE or macrocystic CCAM between 1998 and 2001. Thoracoamniotic shunts were used on 26 occasions in 19 pregnancies. Results: The average gestational age at the diagnosis of PE and CCAM was 22 + 4 and 20 + 0 weeks, respectively. Shunts were offered in pregnancies complicated by hydrops or at significant risk for pulmonary hypoplasia. Shunts were placed at 26 + 2 weeks (average) and 23 + 1 weeks (average) in the PE and CCAM groups, respectively. In CCAM patients, the mean pre- and postshunting mass volumes were 50.5 and 25.7 cm³, representing a 51% reduction in mass volume following shunt placement. In the PE group, the average delivery age was 33 + 5 weeks, with an average shunt placement to delivery time of 7 + 3 weeks. In the CCAM group, the average delivery was 33 + 3 weeks, with an average shunt placement to delivery time of 10 + 2 weeks. The postnatal survival rates were 67% (6/9) and 70% (7/10) in the PE and CCAM groups, respectively. Conclusions: (1) Thoracoamniotic shunts should be considered as a treatment option for selected PE or macrocystic CCAM fetuses with hydrops or a significant risk for pulmonary hypoplasia; (2) the neonatal survival with shunting was similar for PE and CCAM groups and was improved as compared with literature reports, and (3) fetuses with CCAM presented earlier with hydrops than those with PE. Successful shunting resulted in a prolongation of pregnancy into the 3rd trimester in both groups.

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Section: Discussionmentioning

confidence: 99%

“…Fetal PEs are divided into primary and secondary causes [5][6][7][8]. Primary PEs (lymphatic malformation) are considered for in utero therapy, as secondary PEs are usually due to associated abnormalities such as cardiac defects, anemia, infection, and aneuploidy.…”

Section: Discussionmentioning

confidence: 99%

Thoracoamniotic Shunts: Fetal Treatment of Pleural Effusions and Congenital Cystic Adenomatoid Malformations

et al. 2004

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“…Causes of primary chylothorax include congenital atresia of the upper part of the thoracic duct and a congenital lymphangiectactic malformation that can cause the development of lymphatic‐pleural fistula and chylothorax11.…”

Section: Discussionmentioning

confidence: 99%

A new successful therapy for fetal chylothorax by intrapleural injection of maternal blood

Parra

Amenedo

Muñiz‐Díaz

et al. 2003

Ultrasound in Obstet & Gyne

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“…The issue of treating pleural effusions is nowadays being reviewed [1] . Two cases with antenatal intrapleural injection of OK-432 reported a good outcome.…”

Section: Discussionmentioning

confidence: 99%

Intrathoracic Pressure in Congenital Chylothorax: Keystone for the Rationale of Thoracoamniotic Shunting?

Yamamoto

Insunza²,

Carrillo³

et al. 2007

Fetal Diagn Ther

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Thoracoamniotic shunting in fetal pleural effusion has poor results, with an overall survival of less than 50% when hydrops is associated. Those cases without hydrops presented the best evolution, but the indication in these cases remains controversial. We present a dichorionic diamniotic twin pregnancy at 29 weeks’ with right pleural effusion and hydrops, in which one fetus presented diaphragm inversion and mediastinal shift, both considered as ultrasonographic signs of thoracic hypertension. A thoracoamniotic shunt reversed these signs immediately. Nevertheless, 1 week after, these signs and skin edema reappeared and the effusion increased, leading to a second thoracocenthesis for drainage and intrathoracic pressure measurement. Amniotic fluid and intrathoracic pressures were found at 21 and 39 mm Hg, respectively. A cesarean section was performed and the catheter was found to be obliterated by cellular detritus of leukocytes and fibrin. Our conclusion is that ultrasonographic signs of elevated thoracic pressure are a keystone for the shunt indication, and that this could be corroborated by direct measurements. This can be an important parameter for precise indication of thoracoamniotic shunting.

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How do we counsel patients carrying a fetus with pleural effusions?

Cited by 9 publications

References 26 publications

Thoracoamniotic Shunts: Fetal Treatment of Pleural Effusions and Congenital Cystic Adenomatoid Malformations

Thoracoamniotic Shunts: Fetal Treatment of Pleural Effusions and Congenital Cystic Adenomatoid Malformations

A new successful therapy for fetal chylothorax by intrapleural injection of maternal blood

Intrathoracic Pressure in Congenital Chylothorax: Keystone for the Rationale of Thoracoamniotic Shunting?

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