Perinatal outcome following fetal chest shunt insertion for pleural effusion

Ultrasound Obstet Gynecol. 2010 Jul;36(1):58-64. doi: 10.1002/uog.7507.

Abstract

Objective: To evaluate perinatal outcome of fetuses with primary pleural effusions following pleuroamniotic shunting.

Methods: This was a retrospective study of 88 fetuses with large pleural effusions referred to a tertiary fetal medicine unit between 1991 and 2008 which, after a thorough work-up, underwent pleuroamniotic shunting.

Results: At presentation, 59 (67.0%) fetuses were hydropic and 67 (76.1%) had bilateral effusions. In 17 (19.3%) fetuses, pleural fluid was aspirated prior to shunting and in 71 (80.7%), shunts were inserted directly as the first procedure. Mean gestational age at shunting was 27.6 (range, 18-37) weeks and at delivery 34.2 (range, 19-42) weeks. Seventy-four (84.1%) babies were born alive, of whom 52 (70.3%) survived the neonatal period. Of 59 hydropic fetuses, 10 (16.9%) died @ in utero and 18 neonates (30.5%) died, resulting in perinatal survival of 52.5%, whereas of 29 non-hydropic fetuses, perinatal survival was 72.4%. Hydrops resolved following shunting in 28 fetuses, of whom 71% survived, compared to 35% survival in 31 fetuses where hydrops persisted (P = 0.006). Of 22 neonatal deaths, seven were related to pulmonary hypoplasia, five to genetic syndromes, two to aneuploidy and one to a congenital anomaly (truncus arteriosus). Overall 13 (14.8%) were diagnosed with a chromosomal, genetic or other condition, several of which could not have been diagnosed antenatally.

Conclusion: Carefully selected fetuses with primary pleural effusions can benefit from pleuroamniotic shunting, allowing hydrops to resolve with a survival rate of almost 60%.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Amnion
  • Catheters, Indwelling*
  • Female
  • Fetal Diseases / diagnostic imaging
  • Fetal Diseases / mortality
  • Fetal Diseases / therapy*
  • Gestational Age
  • Humans
  • Hydrops Fetalis / diagnostic imaging
  • Hydrops Fetalis / mortality
  • Hydrops Fetalis / therapy*
  • Male
  • Pleural Effusion / diagnostic imaging
  • Pleural Effusion / mortality
  • Pleural Effusion / surgery*
  • Pleural Effusion / therapy*
  • Pregnancy
  • Pregnancy Outcome
  • Retrospective Studies
  • Ultrasonography, Prenatal
  • Young Adult