Perinatal outcome following fetal chest shunt insertion for pleural effusion

Y. Yinon, S. Grisaru-Granovsky, V. Chaddha, R. Windrim, P. G.R. Seaward, E. N. Kelly, O. Beresovska, G. Ryan

Research output: Contribution to journalArticlepeer-review

Abstract

Objective To evaluate perinatal outcome of fetuseswith primary pleural effusions following pleuroamnioticshunting. Methods This was a retrospective study of 88 fetuses withlarge pleural effusions referred to a tertiary fetal medicineunit between 1991 and 2008 which, after a thoroughwork-up, underwent pleuroamniotic shunting. Results At presentation, 59 (67.0%) fetuses werehydropic and 67 (76.1%) had bilateral effusions. In 17(19.3%) fetuses, pleural fluid was aspirated prior to shuntingand in 71 (80.7%), shunts were inserted directly asthe first procedure. Mean gestational age at shunting was27.6 (range, 18-37) weeks and at delivery 34.2 (range, 19-42) weeks. Seventy-four (84.1%) babies were bornalive, of whom 52 (70.3%) survived the neonatal period. Of 59 hydropic fetuses, 10 (16.9%) died in utero and18 neonates (30.5%) died, resulting in perinatal survivalof 52.5%, whereas of 29 non-hydropic fetuses, perinatalsurvival was 72.4%. Hydrops resolved following shuntingin 28 fetuses, of whom 71% survived, comparedto 35% survival in 31 fetuses where hydrops persisted(P = 0.006). Of 22 neonatal deaths, seven were relatedto pulmonary hypoplasia, five to genetic syndromes, twoto aneuploidy and one to a congenital anomaly (truncusarteriosus). Overall 13 (14.8%) were diagnosed with achromosomal, genetic or other condition, several of whichcould not have been diagnosed antenatally. Conclusion Carefully selected fetuses with primary pleuraleffusions can benefit from pleuroamniotic shunting, allowing hydrops to resolve with a survival rate of almost60%.

Original languageEnglish
Pages (from-to)58-64
Number of pages7
JournalUltrasound in Obstetrics and Gynecology
Volume36
Issue number1
DOIs
StatePublished - Jul 2010
Externally publishedYes

Keywords

  • Fetal pleural effusion
  • Fetal therapy
  • Hydrops
  • Hydrothorax
  • Pleuroamniotic shunt

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