[Thoracoamniotic shunts and thoracocentesis in fetal therapy].
BACKGROUND
The not heart thoracic anomalies are caused by different abnormalities in the embryonic period with similar physiopathologic mechanisms. The prenatal treatment by means of decompression can improve substantially the clinical results in these patients.


OBJECTIVE
To evaluate, in a qualitative way, the effect of the thoracoamniotic shunts and thoracocentesis in the perinatal outcome in fetuses with not heart thoracic anomalies.


METHODS
Twenty-two articles were revised describing 308 cases of fetuses with congenital cystic adenomatoid malformation (CCAM), 25 cases of hydrothorax and 55 cases of broncopulmonary sequestration (BPS). We analyzed the adverse prognostic factors that indicated the treatment election in uterus as well as complications and perinatal outcome.


RESULTS
Of the 388 cases of not heart thoracic anomalies, 250 fetuses were managed conservatively, and in 102 fetuses handling in uterus was started. Hydrops was identified as the worst prognostic factor to these fetuses, with a survival rate of 55.7%. The global survival was of 56.5% (155 cases) in the fetuses with CCAM, 98.1% (52 cases) in the fetuses with BPS and of 80% (20 cases) in the fetuses with hydrothorax.


CONCLUSIONS
When having a fetus with some of these pathologies, it should be evaluated in an individual and integral way; according to the gestational age when diagnosed, as well as the type of lesion and the presence or absence of fetal dropsy to decide between fetal therapy or expectant handling.
Gallardo Gaona
Juan Manuel
JM
Instituto Nacional de Perinatología.
Guzmán Huerta
Mario Estanislao
ME
Acevedo Gallegos
Sandra
S
Velázquez Torres
Berenice
B
Zapien Ovando
Amparo Liliana
AL
D000650:Amnion; D001998:Bronchopulmonary Sequestration / Q000601:surgery*; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005333:Fetus / Q000601:surgery*; D006801:Humans; D006876:Hydrothorax / Q000601:surgery*; D019152:Paracentesis / Q000379:methods; D011247:Pregnancy; D013903:Thoracic Surgery / Q000379:methods