title: The prognostic factors and outcomes of primary fetal hydrothorax with the effects of fetal intervention.
abstract: OBJECTIVE
  This study aims to determine the prognostic factors and outcomes of primary fetal hydrothorax (FHT) and investigate the effects of fetal therapy.
  
  
  METHODS
  A nationwide survey was conducted on fetuses with primary FHT delivered after 22 weeks of gestation between January 2007 and December 2011 at perinatal centers.
  
  
  RESULTS
  Among the 287 cases of primary FHT, the survival rates for those with and without hydrops were 58.0% (113/195) and 97.8% (90/92), respectively. The survival rates in the no-therapy, thoracocentesis, and thoracoamniotic shunting (TAS) groups in the hydropic cases and the non-hydropic cases were 59.7% (40/67), 51.5% (35/68), and 63.3% (38/60) and 98.1% (53/54), 96.3% (26/27), and 100% (11/11), respectively. The crude relative risk for death was 2.1 (p = 0.005) for fetuses diagnosed at 26 to 30 weeks of gestational age (vs ≥30 weeks), 2.3 (p = 0.001) for both skin edema and ascites, and 3.1 (p = 0.02) for bilateral pleural effusion. TAS was associated with a significant risk reduction for death in hydropic cases [adjusted relative risk 0.61, p = 0.01 (vs no fetal therapy)].
  
  
  CONCLUSIONS
  Hydrops and an early gestational age at diagnosis (<30 weeks of gestation), skin edema with ascites, and bilateral effusion predicted a poor prognosis in primary FHT cases. TAS was associated with a higher survival rate. © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Wada
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Seung Chik
authors.initials: SC
authors.lastname: Jwa
authors.affiliation: Department of Obstetrics and Gynecology, Kyushu University Hospital, Kyushu University, Fukuoka, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Yumoto
authors.affiliation: Department of Fetal-Maternal Medicine, Nagara Medical Center, Gifu, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Usui
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sago
mesh_terms: D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D046128:Fetal Therapies / Q000379:methods / Q000401:mortality; D006801:Humans; D015160:Hydrops Fetalis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D006876:Hydrothorax / Q000151:congenital / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal