title: Outcomes of fetal intervention for primary hydrothorax.
abstract: OBJECTIVE
  Primary hydrothorax is a rare congenital anomaly with outcomes ranging from spontaneous resolution to fetal demise. We reviewed our experience with fetuses diagnosed with primary hydrothorax to evaluate prenatal management strategies.
  
  
  METHODS
  We reviewed the records of patients evaluated for fetal pleural effusions at our Fetal Treatment Center between 1996 and 2013. To define fetuses with primary hydrothorax, we excluded those with structural or genetic anomalies, diffuse lymphangiectasia, immune hydrops, and monochorionic diamniotic twin gestations.
  
  
  RESULTS
  We identified 31 fetuses with primary hydrothorax, of whom 24 had hydrops. Hydropic fetuses were more likely to present with bilateral effusions. Of all fetuses with primary hydrothorax, 21 had fetal interventions. Survival without hydrops was 7/7 (100%), whereas survival with hydrops depended on whether or not the patient had fetal intervention: 12/19 (63%) with intervention and 1/5 (20%) without intervention. Premature delivery was common (44%) among those who had fetal intervention.
  
  
  CONCLUSIONS
  Fetal intervention for primary hydrothorax may lead to resolution of hydrops, but preterm birth and neonatal demise still occur. Understanding the pathophysiology of hydrops may provide insights into further prenatal management strategies, including targeted therapies to prevent preterm labor.
authors.affiliation: Fetal Treatment Center, University of California, San Francisco, CA, USA; Department of Surgery, University of California, San Francisco, CA, USA.
authors.forename: S Christopher
authors.initials: SC
authors.lastname: Derderian
authors.affiliation: Fetal Treatment Center, University of California, San Francisco, CA, USA; Department of Surgery, University of California, San Francisco, CA, USA.
authors.forename: Shivika
authors.initials: S
authors.lastname: Trivedi
authors.affiliation: Fetal Treatment Center, University of California, San Francisco, CA, USA.
authors.forename: Jody
authors.initials: J
authors.lastname: Farrell
authors.affiliation: Fetal Treatment Center, University of California, San Francisco, CA, USA; Department of Neonatology, University of California, San Francisco, CA, USA.
authors.forename: Roberta L
authors.initials: RL
authors.lastname: Keller
authors.affiliation: Fetal Treatment Center, University of California, San Francisco, CA, USA; Department of Obstetrics, University of California, San Francisco, CA, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Rand
authors.affiliation: Fetal Treatment Center, University of California, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Goldstein
authors.affiliation: Fetal Treatment Center, University of California, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA.
authors.forename: Vickie A
authors.initials: VA
authors.lastname: Feldstein
authors.affiliation: Fetal Treatment Center, University of California, San Francisco, CA, USA; Department of Surgery, University of California, San Francisco, CA, USA.
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Hirose
authors.affiliation: Fetal Treatment Center, University of California, San Francisco, CA, USA; Department of Surgery, University of California, San Francisco, CA, USA. Electronic address: Tippi.Mackenzie@ucsfmedctr.org.
authors.forename: Tippi C
authors.initials: TC
authors.lastname: MacKenzie
mesh_terms: D002140:California / Q000453:epidemiology; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D046128:Fetal Therapies / Q000379:methods*; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D006876:Hydrothorax / Q000000981:diagnostic imaging / Q000196:embryology / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
keywords: Congenital chylothorax; Hydrops; Pleural effusion; Primary hydrothorax; Thoracoamniotic shunt