title: Thoracoamniotic Shunting for Fetal Hydrothorax: Predictors of Intrauterine Course and Postnatal Outcome.
abstract: OBJECTIVE
  To assess predictors for survival and complications among a relatively large cohort of fetuses with hydrothorax treated by thoracoamniotic shunting.
  
  
  METHODS
  All cases with hydrothorax treated by thoracoamniotic shunting in a 10-year period (2002-2011) in two centers were retrospectively reviewed.
  
  
  RESULTS
  A total of 78 fetuses with hydrothorax treated with thoracoamniotic shunting were included in the study. Mean gestational age at diagnosis was 25.6 weeks (12-34 weeks). Initial thoracoamniotic shunting was performed at a mean gestational age of 26.5 weeks (16-33 weeks). A mean of 2.53 shunts (1-7) were inserted per fetus. Of the 78 fetuses, 9 (11.5%) died in utero, 69 (88.5%) were born alive and 46 (59%) survived. Prognostic markers significantly associated with nonsurvival were polyhydramnios, hydrops placentae and mediastinal shift at initial scan, onset of hydrops after first shunt placement, rupture of membranes, a shunt-birth interval <4 weeks and low gestational age at birth. In our cohort, fetuses with trisomy 21 had a significantly better survival than euploid fetuses.
  
  
  CONCLUSIONS
  Although associated with a significant rate of repeated interventions, thoracoamniotic shunting in fetuses with severe hydrothorax results in an overall survival rate of 59%. Fetuses with hydrothorax and trisomy 21 have a better survival when compared to euploid fetuses.
authors.affiliation: Division of Fetal Surgery, Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Mallmann
authors.forename: Viola
authors.initials: V
authors.lastname: Graham
authors.forename: Bettina
authors.initials: B
authors.lastname: Rösing
authors.forename: Ingo
authors.initials: I
authors.lastname: Gottschalk
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gembruch
authors.forename: Annegret
authors.initials: A
authors.lastname: Geipel
authors.forename: Christoph
authors.initials: C
authors.lastname: Berg
mesh_terms: D002916:Chylothorax / Q000151:congenital* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D004314:Down Syndrome / Q000150:complications; D005260:Female; D046128:Fetal Therapies / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging / Q000401:mortality; D006831:Polyhydramnios / Q000000981:diagnostic imaging / Q000401:mortality; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D013907:Thoracostomy / Q000379:methods; D016896:Treatment Outcome