Intrathoracic Displacement of Pleuroamniotic Shunt after Successful in utero Treatment of Fetal Hydrops Secondary to Hydrothorax

Abstract

Background: Primary fetal pleural effusion can be associated with high perinatal morbidity and mortality, especially when it is associated with the presence of fetal hydrops. Pleuroamniotic shunting results in effective drainage and lung expansion which prolong the pregnancy and improve neonatal survival. Intrathoracic displacement of the shunt is a rare but a known complication of shunt insertion and can cause some infant morbidity. We present a case of successful antenatal treatment of primary fetal pleural effusion complicated with intrathoracic displacement of the shunt without any fetal and long-term infant morbidity. Case Report: Our case presented with severe bilateral fetal pleural effusion, causing fetal hydrops treated successfully by pleuroamniotic shunting at 25 weeks of gestation which was complicated by dislodgement of the shunt into the fetal chest documented by antenatal ultrasound at 30 weeks. There was no recurrence of fetal pleural effusion or other antenatal complication. After delivery there were no postnatal complications, so removal of the shunt was not considered, and clinical follow-up of the infant to the age of 12 months was uneventful. Conclusion: The complication of intrathoracic displacement of a pleuroamniotic shunt can be recognized antenatally by ultrasound. Since there are no postnatal pulmonary complications related to the presence of the shunt inside the infant chest, conservative management in these cases appears to be a safe approach.

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

“…There is no evidence for which is best mode of delivery (vaginally or caesarean section), even if in rare cases it has been suggested the ex utero intrapartum treatment (EXIT) procedure too [25,28].…”

Ultrasound-Guided Retrieval and Position Replacement of a Dislodged Fetal Pleuro-Amniotic Shunt: A Novel Approach for a Known Complication of Feto-Amniotic Shunting

“…Large amounts of pleural fluid can compress the lung and heart and lead to abnormal lung development, fetal hydrops, and even fetal death. Pleuro-amniotic shunting has been utilized to improve perinatal outcomes [1,2,3,4,5]. However, the procedure is not without risks.…”

“…However, the procedure is not without risks. Known complications of shunting include ruptured membranes, preterm labor, shunt malfunction due to blockage, and shunt dislodgement both into the amniotic cavity and the fetal thorax [1,2,3,4,5]. …”

“…In all 3 cases, the shunt was never removed from the neonatal thoracic cavity and although the neonates had no complications on follow-up from 10 months to 2 years, 2 of the 3 neonates developed respiratory distress, and 1 neonate required mechanical ventilation for 11 days. Another report by Alkazaleh et al [3] describes internalization of a pleuro-amniotic shunt with no attempt at neonatal removal and no neonatal respiratory complications with up to 1 year of follow-up. Neonatal removal of dislodged shunts has been suggested when infants require chest tube drainage because of persistent pleural effusions.…”

Thoracoscopic Removal of Retained Thoracoamniotic Shunt Catheters in Newborns

“…Some authors 13,14 have suggested conservative treatment without surgical removal. Their follow-up (24 and 12 months, respectively) did not revealed significant complications.…”