Intrapartum drainage of fetal pleural effusion

Abstract

Our objective was to describe our experience with intrapartum thoracocentesis in fetuses with severe bilateral pleural effusion. We describe the outcome of four consecutive cases of fetal pleural effusion due to chylothorax that were managed by intrapartum thoracocentesis. These fetuses were not candidates for pleuro‐amniotic shunting either because of the need for prompt delivery (three fetuses) or because of advanced gestational age (one fetus). Thoracocentesis was performed in the operating theatre under ultrasound guidance prior to Caesarean delivery. Gestational age at the time of diagnosis and thoracocentesis ranged between 26–34 weeks and 31–34 weeks respectively. Bilateral thoracocentesis was performed in two fetuses and unilateral in the remaining two fetuses. All four infants were born in a relatively good condition; however, all eventually required intubation, ventilation and chest tubes. Chest tubes were introduced between 2 h and 5 days after delivery in three infants, and immediately after birth in one infant who was hydropic. Two infants survived and are developing normally. One infant died from sepsis following successful pleurodesis and one from aspiration on day 51. Our conclusions are that intrapartum thoracocentesis seems to be a relatively simple procedure, that allows newborns with pleural effusion, to breathe spontaneously or be more easily ventilated. This in turn, reduces the need to introduce chest tubes in an emergency situation. Copyright © 1999 John Wiley & Sons, Ltd.

Perinatal outcomes of fetal pleural effusion following thoracoamniotic shunting

“…Fetal pleural effusion (PE) is an accumulation of fluid in the fetal thorax and can occur either primarily or secondarily. This pathologic finding is a rare condition with an incidence of 1 in 10 000–15 000 pregnancies . Primary PE is due to lymphatic leakage, whereas secondary PE is caused by conditions such as cardiac malformation, fetal anemia or infection, aneuploidy, or structural anomalies that can compress the lungs and mediastinum .…”

“…Fetal PE may be unilateral or bilateral, with a highly varied clinical course ranging from spontaneous resolution to progression to fetal hydrops and perinatal death . Mild PE will occasionally resolve or remain stable, whereas large volumes of pleural fluid may disturb normal lung development and lead to polyhydramnios with compression of the esophagus . In addition, fetal hydrops can develop with reduced cardiac output resulting from increased intrathoracic pressure …”

Successful Management of Fetal Hydrothorax associated with Hydrops

“…Chylothorax is diagnosed by cytological and biochemical analysis of the fluid aspirate: Yellow-colored, with lymphocyte count >70-80%, and fluid protein and cholesterol lower than their serum counterparts. 2,3 The prognosis depends largely on the underlying cause. Perinatal outcomes are worsened by associated malformations (as much as 25%) and aneuploidy (7-12% of all cases).…”

“…1,2 While mild effusions remain stable or resolve, large effusions are associated with mass effect leading to mediastinal shift, pulmonary hypoplasia, hydrops, and/ or abnormal cardiac function or arrhythmias. [2][3][4] Fetuses presenting with hydrops and polyhydramnios due to large pleural effusion are at risk for preterm delivery and perinatal death due to pulmonary hypoplasia or heart failure. 5 We present a case of unilateral large pleural effusion associated with hydrops in a fetus with anterior placenta…”

Cirurgia fetal no contexto atual

“…O derrame pleural constitui-se num achado patológico raro, com incidência de 1 em cada 10.000-15.000 gestações 64,65 . Consiste no acúmulo de fluido no tórax fetal, podendo ser primário ou secundário.…”