Noninvasive management of isolated bilateral fetal hydrothorax

124

Thoraco-amniotic shunting was performed in 51 singleton pregnancies for decompression and chronic drainage of fetal pleural effusions (n = 47), pericardial effusion (n = 1), or pulmonary cysts (n = 3). Five fetuses had chromosomal defects and in 4 the parents elected termination of pregnancy. All 18 non-hydropic fetuses and 14 of the 28 with hydrops survived. Thoraco-amniotic shunting is useful for diagnostic evaluation and treatment of fetuses with pathologic collection of intrathoracic fluid.

Section: Neonatal Thoracocentesismentioning

confidence: 99%

“…Furthermore, Longaker et al [12] and Pijpers et al [16] examined the natural history of antenatally diagnosed pleural effusions in 24 and 8 cases, respectively, and reported sponta neous resolution in a total of 5 fetuses.…”

Section: Spontaneous Resolutionmentioning

confidence: 99%

Thoraco-Amniotic Shunting

Nicolaides¹,

Azar²

1990

124

“…28 weeks' gestation is an independent bad prognostic factor with high perinatal mortality rate [5] . Some pleural effusions may resolve spontaneously before birth [6] . Prenatal intervention by fetal thoracocentesis [7] and shunt placement [8,9] has significantly improved the perinatal mortality due to lung expansion after drainage, resolution of fetal hydrops and polyhydramnios (where present) leading to pregnancy prolongation [8] .…”

Section: Introductionmentioning

confidence: 99%

Intrathoracic Displacement of Pleuroamniotic Shunt after Successful in utero Treatment of Fetal Hydrops Secondary to Hydrothorax

Alkazaleh¹,

Saleem²,

Badran

2009

Background: Primary fetal pleural effusion can be associated with high perinatal morbidity and mortality, especially when it is associated with the presence of fetal hydrops. Pleuroamniotic shunting results in effective drainage and lung expansion which prolong the pregnancy and improve neonatal survival. Intrathoracic displacement of the shunt is a rare but a known complication of shunt insertion and can cause some infant morbidity. We present a case of successful antenatal treatment of primary fetal pleural effusion complicated with intrathoracic displacement of the shunt without any fetal and long-term infant morbidity. Case Report: Our case presented with severe bilateral fetal pleural effusion, causing fetal hydrops treated successfully by pleuroamniotic shunting at 25 weeks of gestation which was complicated by dislodgement of the shunt into the fetal chest documented by antenatal ultrasound at 30 weeks. There was no recurrence of fetal pleural effusion or other antenatal complication. After delivery there were no postnatal complications, so removal of the shunt was not considered, and clinical follow-up of the infant to the age of 12 months was uneventful. Conclusion: The complication of intrathoracic displacement of a pleuroamniotic shunt can be recognized antenatally by ultrasound. Since there are no postnatal pulmonary complications related to the presence of the shunt inside the infant chest, conservative management in these cases appears to be a safe approach.

“…infections, blood dyscrasias, aneuploidy, structural anomalies, cardiac arrhythmias and fetomaternal hemorrhage). Unilateral effusions may spontaneously resolve [8] or progress to bilateral effusions and hydrops fetalis, mostly due to cardiac compression, resulting in a low cardiac output state [2,9]. Persistent lung compression at midtrimester, even in the absence of hydrops fetalis, may lead to lung hypoplasia and respiratory failure at birth.…”

Section: Discussionmentioning

confidence: 99%

Mid-Trimester Thoracoamniotic Shunting for the Treatment of Fetal Primary Pleural Effusions in a Twin Pregnancy

Grisaru‐Granovsky¹,

Seaward²,

Windrim³

et al. 2000

Thoracoamniotic shunting has been described as having a beneficial role in the antenatal management of primary pleural effusions in singleton pregnancies. We report a case of a twin pregnancy in which progressive pleural effusions and hydrops were diagnosed in one of the fetuses at 16 weeks of gestation. An initial evaluation ruled out underlying genetic and anatomic abnormalities in both twins. At 19 weeks gestation, the first procedure of bilateral thoracoamniotic shunting was performed in the affected fetus, subsequent to which the lungs re-expanded and the hydrops resolved. Three additional shunt replacements and one therapeutic amniocentesis were required on follow-up. At 35 weeks, labor was induced. The first fetus (healthy) was delivered vaginally and the second fetus (affected) was delivered by cesarean section. Both neonates are healthy at one year follow-up.