Mid-Trimester Thoracoamniotic Shunting for the Treatment of Fetal Primary Pleural Effusions in a Twin Pregnancy

Grisaru‐Granovsky, Sorina; Seaward, P. G. R.; Windrim, Rory; Wyatt, Phil; Kelly, Edmond; Ryan, Greg

doi:10.1159/000021007

Cited by 6 publications

(7 citation statements)

References 15 publications

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“…Other PE techniques reported include singleneedle aspiration [29], pleurodesis with OK-432 [30,31], maternal diet [32], intrapartum drainage [33], and shunting in a twin gestation [34]. Bruner et al [35] used percutaneous laser ablation on a microcystic CCAM at 23 weeks of gestation, and, although the tumor size decreased, there was worsening of the hydrops, and fetal death occurred.…”

Section: Discussionmentioning

confidence: 99%

Thoracoamniotic Shunts: Fetal Treatment of Pleural Effusions and Congenital Cystic Adenomatoid Malformations

et al. 2004

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Objective: To determine whether fetuses that underwent thoracoamniotic shunt placement for treatment of pleural effusion (PE) or macrocystic congenital cystic adenomatoid malformation (CCAM) have an improved outcome as compared with an untreated population. Methods: A retrospective review from a single tertiary center was performed using thoracoamniotic shunt placement to treat PE or macrocystic CCAM between 1998 and 2001. Thoracoamniotic shunts were used on 26 occasions in 19 pregnancies. Results: The average gestational age at the diagnosis of PE and CCAM was 22 + 4 and 20 + 0 weeks, respectively. Shunts were offered in pregnancies complicated by hydrops or at significant risk for pulmonary hypoplasia. Shunts were placed at 26 + 2 weeks (average) and 23 + 1 weeks (average) in the PE and CCAM groups, respectively. In CCAM patients, the mean pre- and postshunting mass volumes were 50.5 and 25.7 cm³, representing a 51% reduction in mass volume following shunt placement. In the PE group, the average delivery age was 33 + 5 weeks, with an average shunt placement to delivery time of 7 + 3 weeks. In the CCAM group, the average delivery was 33 + 3 weeks, with an average shunt placement to delivery time of 10 + 2 weeks. The postnatal survival rates were 67% (6/9) and 70% (7/10) in the PE and CCAM groups, respectively. Conclusions: (1) Thoracoamniotic shunts should be considered as a treatment option for selected PE or macrocystic CCAM fetuses with hydrops or a significant risk for pulmonary hypoplasia; (2) the neonatal survival with shunting was similar for PE and CCAM groups and was improved as compared with literature reports, and (3) fetuses with CCAM presented earlier with hydrops than those with PE. Successful shunting resulted in a prolongation of pregnancy into the 3rd trimester in both groups.

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Section: Discussionmentioning

confidence: 99%

Thoracoamniotic Shunts: Fetal Treatment of Pleural Effusions and Congenital Cystic Adenomatoid Malformations

et al. 2004

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“…1,3 Pleuroamniotic shunting has been shown effective in providing longterm intrauterine drainage after gestational week 22, 2,3,27-32 and shunting was shown to be effective in early second trimester (gestational weeks 17 and 19) in two case reports. 8,9 However, it is a technically difficult procedure because of the relatively large gauge of the instruments needed for placing the shunts, and shunt replacements are often required. Further, the position of the fetus and the placenta may prevent the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…However, only two cases have described successful pleuroamniotic shunting in early second trimester. 8,9 Pleuroamniotic shunting is a technically difficult procedure, particularly at early gestational age, associated with adverse effects such as preterm labor, which is a poor prognostic factor. 1,2 Further, the position of the fetus and the placenta may prevent the procedure.…”

Section: Level Of Evidence: IImentioning

confidence: 99%

New Treatment of Early Fetal Chylothorax

Nygaard¹,

Sundberg

Nielsen

et al. 2007

Obstetrics &Amp; Gynecology

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“…In the vast majority of the cases, the procedure was carried out during the late second trimester. In only five cases was the shunt inserted between 20 and 22 weeks (Nicolaides and Azar, 1990;Morrow et al, 1995) and in only one case was the procedure performed at 19 weeks (Grisaru-Granovsky et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Successful early in utero management of fetal hydrothorax in a twin pregnancy

2003

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We present a case of dichorionic diamniotic twin pregnancy in which one of the fetuses was found to have a major pleural effusion at 15 weeks of gestation. A single-needle pleural fluid aspiration was performed at 15 and 16 weeks, but the fluid reaccumulated quickly after each procedure and at 16 weeks, the fetus was found to become progressively hydropic. A shunt was then successfully inserted at 17 weeks, which is the earliest gestation reported so far in the literature for such a procedure to treat isolated hydrothorax. Because we felt that the fetus would be too small for a classical double-pigtail pleuroamniotic shunt, we used a multilength double-pigtail bladder stent (Harrison drain; Cook; Spencer; Indiana; USA) via a 13-gauge echo tip trocar. This shunt could be used for both singleton and twin pregnancies presenting with fetal pleural effusion from as early as 16 to 17 weeks to prevent the development of fetal hydrops and polyhydramnios and subsequent premature delivery. Treatment at this stage of gestation would also minimize the risk of lung hypoplasia, which is the main clinical issue when shunts are inserted after 24 weeks.

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Mid-Trimester Thoracoamniotic Shunting for the Treatment of Fetal Primary Pleural Effusions in a Twin Pregnancy

Cited by 6 publications

References 15 publications

Thoracoamniotic Shunts: Fetal Treatment of Pleural Effusions and Congenital Cystic Adenomatoid Malformations

Thoracoamniotic Shunts: Fetal Treatment of Pleural Effusions and Congenital Cystic Adenomatoid Malformations

New Treatment of Early Fetal Chylothorax

Successful early in utero management of fetal hydrothorax in a twin pregnancy

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