SFM Fetal Therapy Practice Guidelines: Fetal Shunts

Abstract

AbstractFetal shunt is placed into the fetus in order to drain fluid from a fluid-filled fetal area into the amniotic cavity. The main indications are hydrothorax, congenital pulmonary airway malformation (CPAM) with dominant cyst, and lower urinary tract obstruction.Fetal shunt is indicated if the hydrothorax is primary or hypertensive. In case of re-accumulation after a diagnostic tap or if the primary hydrothorax has led to a secondary nonimmune hydrops provided the primary nature is clearly established and in cases where gestational age is less than 34 weeks.A shunt in CPAM is indicated in case of CPAM with a dominant cyst where the CPAM volume ratio (CVR) is greater than 1.6, where macrocysts are visible within the lesion, where the diameter of the dominant cyst is more than one-third of the largest diameter of the lesion and where presence of hydrops is not a contraindication for shunting. In case of lower urinary tract obstruction, fetal shunt may be indicated if the following conditions are met. The etiology of lower urinary tract obstruction is posterior urethral valve with oligohydramnios and fetal urinalysis is favorable.