General Obstetrics and Gynecology: Obstetrics
Thoracoamniotic shunting for fetal pleural effusions with hydrops

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Objective

The purpose of this study was to evaluate perinatal outcome after thoracoamniotic shunting for fetal pleural effusions with hydrops.

Study design

This was a retrospective study.

Results

Shunting was performed immediately after diagnosis and was successful in all 54 of the cases that were attempted. There were 7 pregnancy terminations, 9 in utero deaths, and 38 live births, of which 7 children died in the neonatal period and 31 children survived. Among the liveborn infants, 27 infants were delivered preterm (71%), of whom 7 infants (15%) had preterm premature rupture of membranes and 4 infants (8.5%) had chorioamnionitis. Perinatal death (23/54 infants; 43%) was related to underlying anomalies (7 cases), pulmonary hypoplasia (5 cases), chorioamnionitis (2 cases), or treatment failure for unknown reasons (9 cases). All 31 survivors had chylothorax; for 28 of the survivors, the chylothorax was primary, and for 3 survivors, the chylothorax was the result of right congenital diaphragmatic hernia, pulmonary sequestration, or Noonan syndrome.

Conclusion

After the shunting, pleural effusion with hydrops has a 57% survival rate; premature delivery is the leading source of morbidity.

Section snippets

Material and methods

Between 1984 and 2002, 54 patients underwent thoracoamniotic shunting for pleural effusions with fetal hydrops. The detailed perinatal outcome and postnatal treatment of the 21 first cases are reported in the previous publication.6 The mean maternal age was 33 years (range, 22-38 years), and the mean parity was 2 (range, 1-5). No patient had a significant family history, and none of the parents were consanguineous.

Among patients who were referred to our fetal medicine unit for fetal pleural

Results

Thoracoamniotic shunting was performed at a mean gestational age of 30 weeks (range, 19-36 weeks). Shunting was bilateral in 37 cases and unilateral in 17 cases (right, 7 cases; left, 10 cases).

Polyhydramnios, which was defined by an amount of amniotic fluid, such that it induced uterine contractions and maternal discomfort, occurred in 22 cases; amniodrainage was required in 14 cases. One to 3.8 liters of amniotic fluid were drained during the shunting procedure.

Shunt placement was performed

Comment

Our results confirm that a survival rate of >50% can be achieved by thoracoamniotic shunting in fetal pleural effusions that are complicated by hydrops. The main morbidity that is associated with the procedure is a substantial risk of PPROM and premature delivery.

Pleural effusion is among the most common indications for in utero shunting since the first reports of pleuroamniotic shunting for fetal hydrothorax by Booth et al,3 Blott et al,4 Rodeck et al.5 The rationale for thoracoamniotic

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