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


METHODS
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.


CONCLUSIONS
After the shunting, pleural effusion with hydrops has a 57% survival rate; premature delivery is the leading source of morbidity.
Picone
Olivier
O
Hôpital Necker-Enfants Malades, AP-HP and Université Paris V, Paris, France.
Benachi
Alexandra
A
Mandelbrot
Laurent
L
Ruano
Rodrigo
R
Dumez
Yves
Y
Dommergues
Marc
M
D000653:Amniotic Fluid; D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006876:Hydrothorax / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D007231:Infant, Newborn; D007234:Infant, Premature; D007752:Obstetric Labor, Premature; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013907:Thoracostomy / Q000379:methods; D016216:Ultrasonography, Prenatal