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Objective: This study examines the role of serial ultrasound in predicting fetal outcomes based on progress, resolution or stability of pleural effusions in primary fetal hydrothorax (PFHT). Methods: Records from consecutive cases of fetal pleural effusions referred to the fetal echocardiography unit over a 12-year period were reviewed. Study patients underwent thorough investigation to rule out secondary causes of pleural effusions. The clinical course was monitored with serial ultrasound studies every 2 weeks until delivery. Pleurocentesis and pleuroamniotic shunts were performed in select cases of PFHT. Fetal survival was the primary outcome variable. Results: Eighteen of 44 patients referred for perinatal evaluation of fetal pleural effusions met the study criteria for PFHT. Diagnosis was made at 28 ± 7 weeks and fetuses delivered at 35 ± 3 weeks’ gestational age. Overall survival was 78%. Effusion progression, greater effusion ratios, earlier gestational age at delivery, and lower Apgar scores at birth were associated with poor outcome. Conservative management was appropriate for most cases. Conclusions: Serial ultrasound studies to evaluate the clinical course of the pleural effusions are essential in the management of PFHT. Expectant management of stable and resolving effusions was appropriate in all cases.

This document reflects emerging clinical and scientific advances on the date issued, and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the SOGC. AbstractObjective: To provide guidelines for the use of antenatal magnesium sulphate (MgSO 4 ) for fetal neuroprotection of the preterm infant .Options: Antenatal MgSO 4 administration should be considered for fetal neuroprotection when women present at ≤ 31+6 weeks with imminent preterm birth, defined as a high likelihood of birth because of active labour with cervical dilatation ≥ 4 cm, with or without preterm pre-labour rupture of membranes, and/or planned preterm birth for fetal or maternal indications .There are no other known fetal neuroprotective agents .Outcomes: The outcomes measured are the incidence of cerebral palsy (CP) and neonatal death . Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1) .Benefits, harms, and costs: Antenatal magnesium sulphate for fetal neuroprotection reduces the risk of "death or CP" (RR 0 .85; 95% CI 0 .74 to 0 .98; 4 trials, 4446 infants), "death or moderatesevere CP" (RR 0 .85; 95% CI 0 .73 to 0 .99; 3 trials, 4250 infants), "any CP" (RR 0 .71; 95% CI 0 .55 to 0 .91; 4, trials, 4446 infants), "moderate-to-severe CP" (RR 0 .60; 95% CI 0 .43 to 0 .84; 3 trials, 4250 infants), and "substantial gross motor dysfunction" (inability to walk without assistance) (RR 0 .60; 95% CI 0 .43 to 0 .83; 3 trials, 4287 women) at 2 years of age . Results were consistent between trials and across the meta-analyses . There is no anticipated significant increase in health care-related costs, because women eligible to receive antenatal MgSO 4 will be judged to have imminent preterm birth .

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