Successful Treatment of Primary Fetal Hydrothorax by Long-Time Drainage from Week 23

Abstract

We report on a case of unilateral primary fetal hydrothorax leading to nonimmunological fetal hydrops (NIHF). The NIHF was treated successfully by inserting two consecutive intrauterine catheters at 23 weeks gestation. The first catheter was dislocated through the uterine wall to the maternal peritoneal cavity. At 36 weeks gestation, the mother had a spontaneous onset of labor after premature rupture of membranes and a normal vaginal delivery of a healthy infant with good perinatal outcome. Shunting of PFHT has rarely been described up to now. This case report supports observations of previous authors that early shunting of pleural effusions may prevent progression of NIHF as well as postnatal pulmonary hypoplasia. Unexpected perinatal complications of fetus, mother or both should not be neglected.

Internalization of Pleuroamniotic Shunt Causing Neonatal Demise

“…Dislocation of the shunt into the amniotic cavity is attributed to the fetus pulling the shunt out [1,3,4], This only requires the placement of a further shunt should the effusion recur. Dislodgement of a shunt into the maternal peritoneal cavity has been reported which necessitated its removal by laparascopy on the 5th postnatal day [15]. Internalization may be caused by a combina tion of fetal growth and fetal breathing move ments [3].…”

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

“…This complication had no consequence on the pregnancy and the ascites resolved spontaneously within a few days. Dislodgment of the catheter into the maternal peritoneal cavity, requiring laparosopic retrieval after delivery has also been reported by another team (Becher et al, 1993). Most fetal complications occur around the time of the procedure and result from internal bleeding or premature rupture of the membranes and delivery.…”

“…The technique of long-term pleuroamniotic shunting in utero was introduced during the 1980s. This technique has been successfully used in the treatment of isolated hydro-or chylothorax and more rarely in cases of pleural effusion secondary to congenital lung abnormalities such as pulmonary sequestration and cystic adenomatoid malformation (Becher et al, 1993). We reviewed 95 cases of pleural effusion in which pleuroamniotic shunts were inserted in utero, which were reported in the international literature over the last 15 years after the technique was first described (Table 1).…”

Fetal Lung Surgery

“…53 The most commonly used technique for thoracoamniotic shunting is described by Rodeck et al 54 This technique has been successfully used in the treatment of isolated hydrothorax and in some cases secondary to pulmonary sequestration or cystic adenomatoid malformation with hydrothorax. 55 As an intervention for thoracoamniotic shunting, a trocar with cannula is introduced into the fetal thorax preferably at the midaxillary line of the fetus. Once the trocar has been introduced into the thorax, a double pigtail catheter is passed through the trocar and then the internal loop is deployed into the cavity by an introducer or pusher.…”