Congenital primary hydrothorax: effect of thoracoamniotic shunting on neonatal clinical outcome

Abstract

Congenital hydrothorax although corrected by thoracoamniotic shunting is complicated by severe respiratory distress. The neonatal outcome may be improved limiting degree of prematurity; the presence of thoracoamniotic shunt is not per se an indication of premature birth, at least until GA>35 weeks and adequate pulmonary maturity is reached.

Thoracoamniotic shunts for the management of fetal lung lesions and pleural effusions: a single-institution review and predictors of survival in 75 cases

“…Additional factors noted to be associated with survival in the current study included GA at birth and unilateral effusions. This concurs with earlier studies which suggested these factors influence survival in the natural history of fetuses with PEs as well as those that undergo shunting [18,19,21,23]. In fetuses with large macrocystic CCAMs, we found survival significantly associated with a greater GA at birth and higher percent reduction in the size of the lung lesion following shunting.…”

Fetal pleural effusion and Down syndrome

“…Survival rates have improved significantly in recent years, and Wada et al (21) reported survival rates of 58% and 97.8%, respectively, that can be largely attributed to improved methods of neonatal treatment. Thoracentesis is easy to perform and can reduce distress and improve fetal pulmonary development, but the procedure must be repeated after 24-48 hours in many patients, so thoracoamniotic shunting is usually recommended for fetuses with hydrops (65). Recent studies have indicated that the survival rate for congenital hydrothorax with hydrops is around 60% for patients treated with thoracoamniotic shunting, approximately 50% for those treated with thoracentesis, and from 35% to about 60% for those receiving conservative treatment (4,21).…”

Estudo do volume pulmonar fetal na predição dos resultados perinatais de fetos com derrame pleural "isolado

“…4,56 Entre as diversas condutas descritas, encontrou-se, na literatura, a interrupção da gestação (nos países onde esse procedimento é permitido) 3 , a conduta expectante com acompanhamento ultrassonográfico seriado e a terapia fetal invasiva. 3,5,7,50,56,95 Em 1992, Weber e Philipson 17 realizaram a primeira metanálise que analisou as diversas formas de tratamento. Esses autores observaram que a terapia fetal invasiva apresentava os melhores resultados quando comparada com o acompanhamento ultrassonográfico seriado.…”

“…A partir de então, diversas publicações têm demonstrado que o tratamento fetal melhora o prognóstico em casos selecionados 4,15,56,95 , baseado nos seguintes princípios:…”

“…Embora não exista nenhum trabalho randomizado que compare as diferentes estratégias terapêuticas fetais, as revisões da literatura, baseadas em série ou relatos de casos, parecem apontar uma superioridade não significativa na derivação tóraco-amniótica quando comparado com a toracocentese105 . Esses estudos apontam para uma taxa de sobrevivência de 60 a 100% para os fetos não hidrópicos25,50,52,95 e de 44 a 66% para os fetos com hidropisia (Tabela 01).9,14,50,52,56,63,98,106 Tabela 1: Taxa de sobrevivência de acordo com a terapêutica escolhida para tratamento do derrame pleural primário -Revisão da literatura.…”