Long-Term in Utero Drainage of Fetal Hydrothorax

How do we counsel patients carrying a fetus with pleural effusions?

“…Fetal uni-or bilateral hydrothoraces can exist in isolation or in combination with genetic abnormalities, other congenital defects, and tumors of the lung. Furthermore, at the time of diagnosis, pleural effusions in the fetus can be isolated or part of hydrops fetalis 11 . Some of the more common causes of primary chylothorax include congenital atresia of the upper part of the thoracic duct or a congenital lymphangiectactic malformation that could cause the development of a lymphatic-pleural fistula and chylothorax.…”

“…We inform the patient that the risks and possible complications Opinion Santolaya-Forgas due to ultrasound-guided procedures include infection, preterm labor, premature rupture of membranes, maternal or fetal bleeding, leakage of fluid, and pregnancy loss. The longterm outcome of individuals born with hydrothorax is also reviewed using the above described clinical information and stressing the fact that fetal and neonatal mortality is higher when the hydrothorax is associated with generalized hydrops or other fetal anomalies than when it is an isolated finding 11,24 . While discussing alternative management plans we always mention to the patient that fetuses with pleural effusions can be followed expectantly for signs of fetal distress and hydrops since spontaneous in utero resolution of severe bilateral hydrothorax with no active management resulting in an uncomplicated newborn course can occur.…”

“…If the pleural effusion occurs during the second trimester of pregnancy there is a risk of lung hypoplasia and hydrops. To prevent this, and because the fluid has been reported to reaccumulate in the fetus within 6-48 h after aspiration 26,27 long-term drainage may be considered 11 . We explain to the patient that the procedure is carried out under ultrasound guidance.…”

“…If the lungs expand rapidly, the prognosis is good. In contrast, if the effusions fail to drain to the amniotic cavity, the prognosis is bad and pulmonary hypoplasia should be anticipated 11 . We mention to the patient that the main benefits of draining the pleural effusions appear to be easier resuscitation after delivery, resolution of hydramnios and fetal hydrops and possibly, if drainage is of long duration, prevention of pulmonary hypoplasia.…”

Congenital Chylothorax in Neonatal Thyrotoxicosis

“…This high pleural fluid lymphocytosis is consistent with a diagnosis of chylothorax. 8,9 The pleural fluid cultures were negative and other causes of fetal hydrops (Rh and ABO incompatibility, parvovirus infection, and chromosomal aneuploidies) were ruled out. Initially, the infant was clinically and biochemically euthyroid (Table 3).…”