P31.03: Giant bilateral hydrothorax treated in utero and monitored by fetal echocardiography ‐ Case report

Abstract

Fetus with giant hydrothorax and ascites was diagnosed at 25th week of pregnancy. Fetal echocardiography revealed normal heart anatomy with 8 points in Cardiovascular Profile Score (CVPS), (minus one for ascites and hydrothorax). At 26th week of pregnancy pleurocenthesis and amniocenthesis for fetal karyotype were performed. Fetal karyotype was normal however there was re-accumulation of the pleural effusion next week, so at 27th week of pregnancy pleuroamniotic shunt was established. Based on fetal echocardiography CVPS was 8 due to ascites and hydrothorax. Two weeks later there was again re-accumulation of pleural effusion and CVPS was still 8 points. At 29th week of pregnancy second pleuroamniotic shunt was implemented. Four days after second shunting there was no ascites and only rim of hydrothorax. At 31st week of pregnancy the fetus had again fetal echo and hyperoxygenation test which was positive. At 34th week of pregnancy there was still only rim of pleural effusion and no ascites (CVPS was 9). At 35th week there was spontaneous rupture of membrane, however the newborn was delivered by Cesarean section with birth weight 2200g and Apgar scores of 5 and 7. There was only small pleural effusion in left pleural cavity after delivery. The newborn was discharge home at 21 days. Conclusions: Despite dramatic fetal presentation and rapid reaccumulation of hydrothorax, monitoring by fetal echocardiography examinations had shown a safety of repeated fetal needling and double shunting.