Prenatal management and thoracoamniotic shunting in primary fetal pleural effusions: a single centre experience.

Objective Primary fetal pleural effusions are rare. If severe, thoracoamniotic shunting is needed. Our objective was to study the management and outcomes of pleural effusions in our unit. Methods Retrospective analysis of primary fetal hydrothorax between 1991 and 2010. Results Of 41 cases, 23 (56%) were hydropic, and 27 (66%) required shunting. Overall, 2 (4.8%) were diagnosed with a chromosomal condition and 4 (9.6%) with a congenital condition (3 Noonan syndrome, 1 mild structural cardiac defect). There were 5 terminations of pregnancy (TOP), 3 in utero deaths and 33 liveborn neonates (80%). Intact survival rate was 44% (12/27) among those shunted, 56% (23/41) among all cases and 70% (23/33) among all liveborn neonates. Most (87.5%) neonatal deaths occurred in newborns delivered before 34?weeks of gestation. The survival rate was higher in nonhydropic compared with hydropic fetuses (85% vs 47%). There were no procedure-related fetal losses. One in utero death was complicated by fatal maternal amniotic embolism. Conclusion Fetuses with pleural effusions should undergo expert prenatal workup. Hydropic fetuses and those with massive effusions are candidates for thoracoamniotic shunting. (c) 2012 John Wiley & Sons, Ltd.