Resolution of fetal bilateral chylothorax and ascites after two unilateral thoracocenteses

Chen, C.-P.; Chang, Tung-Yao; Wang, W.

doi:10.1046/j.0960-7692.2001.00543.x

Cited by 24 publications

(13 citation statements)

References 6 publications

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“…It is associated with fetal pulmonary hypoplasia especially if developed in the second trimester as a result of impaired lung growth by compression. Antenatal treatment include maternal dietary modifi cation [10] , repeated thoracocentesis [11] , thoracoamniotic shunting, pleurodesis with OK-432 [12][13][14]20] (see table 1 ) or maternal blood [15] . The perinatal mortality rate varies in different series from 15 ϳ 53% [9,17] and generally is poorer if associated with hydrops fetalis, bilaterality, and preterm delivery.…”

Section: Fetal Chylothoraxmentioning

confidence: 99%

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Antenatal Treatment of Chylothorax and Cystic Hygroma with OK-432 in Nonimmune Hydrops fetalis

Chen

Chen²,

Shih³

et al. 2005

Fetal Diagn Ther

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Objectives: To present our experience of using OK-432 in treating fetal cystic hygroma and chylothorax complicated with nonimmune hydrops fetalis. Methods: OK-432 (Picibanil^®) was injected into the fetal pleural cavity or fetal cystic hygroma. Results:Patient 1: A 23-year-old, gravida 2, para 1, was found to have a recurrent fetal chylothorax at GA 29 weeks. Serial amnioreduction and thoracocentesis was performed at GA 31, 32, 33, and 34 weeks. Intrapleural OK-432 injection was performed twice at GA 33 and 34 weeks. Cyanosis and respiratory distress were noted immediately after birth (GA 34 weeks). The baby expired despite of aggressive neonatal resuscitation. Patient 2: A 26-year-old, gravida 2, para 1, was found to have a cystic hygroma of her fetus at GA 17 weeks. Karyotype of the cystic fluid and the amniocytes were 46, XY. Fetal ascites developed at GA 22 weeks. OK-432 injection into the tumour was performed at GA 23 weeks. Stabilization of the cystic hygroma was noted throughout the pregnancy (about 3.5 cm in diameter). Serial fetal paracentesis and/or amnioreduction were performed. Karyotype of the ascites was again 46, XY. Maternal dietary modification with medium chain triglyceride was also prescribed. Chylothorax developed and the baby was born by cesareans at GA 32 weeks. Resolution of pleural effusion, ascites, and regression of cystic hygroma were noted since the 2nd day after birth. The baby had survived beyond 4 months of age at submission. Conclusion: Combination of antenatal OK-432 injection, maternal dietary modification, serial thoracocentesis plus paracentesis, together with amnioreduction and tocolysis, appeared to contribute to the success of antenatal treatment. Fetal pulmonary expansion may determine the immediate neonatal survival.

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Section: Fetal Chylothoraxmentioning

confidence: 99%

“…Maternal dietary modifi cation, thoracocentesis, thoracoamniotic shunt, and pleurodesis with OK-432 or maternal blood, were used in treating fetal chylothorax with some success [10][11][12][13][14][15] . Here we present our experience of using OK-432 in treating fetal chylothorax and cystic hygroma associated with hydrops fetalis.…”

Section: Introductionmentioning

confidence: 99%

Antenatal Treatment of Chylothorax and Cystic Hygroma with OK-432 in Nonimmune Hydrops fetalis

Chen

Chen²,

Shih³

et al. 2005

Fetal Diagn Ther

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“…35 Fetuses with CC are at high risk for chromosomal abnormalities, and rapid diagnosis of fetal karyotype 36 and any other associated malformations is essential to guide further management and prognosis. Therapeutic measures during prenatal period include maternal dietary modification, 37 repeated thoracocentesis, 1,5,38 thoraco-amniotic shunting, 39 and pleurodesis with OK-432. [40][41][42][43][44] Maternal dietary management with lowfat, high medium-chain triglyceride (MCT) diet might help delay the need for thoracentesis in cases of fetal chylothorax.…”

Section: 25mentioning

confidence: 99%

Congenital chylothorax: current perspectives and trends

Krishnamurthy

Malhotra

2017

RRN

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Congenital chylothorax (CC) is the most common cause of pleural effusion in the perinatal period. The etiology is unknown in the majority of the cases. However, in some cases, it can be associated with various syndromes and genetic conditions. CC is associated with a high mortality rate. Most of the clinical manifestations are secondary to pressure effects (pulmonary hypoplasia) and loss of protein and lymphatic fluid (hydrops, malnutrition). Conservative management in the neonatal period is effective in up to 80% of cases and includes pleural drainage, parenteral nutrition/enteral medium-chain triglyceride-based formulae, and medications such as octreotide. Surgical intervention (pleurodesis, thoracic duct ligation/embolization, pleuroperitoneal shunt) may be required in persistent cases. A universal consensus on management of CC is unavailable, and data on the safety of medication use for CC in neonates are sparse.

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“…In this issue of Ultrasound in Obstetrics and Gynecology there are three very interesting papers describing new management options for fetal hydrothorax [1][2][3] . Dr Chen et al 1 describe a case of a fetus with bilateral pleural effusions, ascites and polyhydramnios diagnosed by ultrasound at 30 weeks' gestation.…”

Section: Opinion How Do We Counsel Patients Carrying a Fetus With Plementioning

confidence: 99%

“…Dr Chen et al 1 describe a case of a fetus with bilateral pleural effusions, ascites and polyhydramnios diagnosed by ultrasound at 30 weeks' gestation. At 31 weeks the diagnosis of nonimmune hydrops due to idiopathic fetal chylothorax was made after a maternal work-up, ultrasound evaluation of the fetus, and fetal blood sampling and thoracocentesis procedures had been performed.…”

Section: Opinion How Do We Counsel Patients Carrying a Fetus With Plementioning

confidence: 99%

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

Santolaya-Forgas

2001

Ultrasound in Obstet & Gyne

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Resolution of fetal bilateral chylothorax and ascites after two unilateral thoracocenteses

Cited by 24 publications

References 6 publications

Antenatal Treatment of Chylothorax and Cystic Hygroma with OK-432 in Nonimmune Hydrops fetalis

Antenatal Treatment of Chylothorax and Cystic Hygroma with OK-432 in Nonimmune Hydrops fetalis

Congenital chylothorax: current perspectives and trends

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

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