Successful Management of Severe Idiopathic Fetal Hydrops With Thoracoamniotic Shunts [34P

Abstract

INTRODUCTION: This case report describes successful management of severe idiopathic fetal hydrops with thoracoamniotic shunts. METHODS: Patient is a 38 y/o G2P0010 who initiated care at 6 weeks. She was evaluated by perinatology for AMA and a fibroid uterus. First trimester and anatomy ultrasounds were unremarkable. She had low-risk genetic screening and normal MSAFP. A growth ultrasound at 23 weeks demonstrated bilateral pleural effusions. Evaluation included: normal fetal echocardiogram, Rh positive with no antibodies, negative serum TORCH titers, normal microarray, and negative amniotic fluid TORCH PCR. Due to worsening bilateral pleural effusions and development of fetal hydrops, patient underwent left-sided thoracoamniotic shunt placement at 25 and 26 weeks after receiving antenatal corticosteroids with resolution of left-sided pleural effusion and hydrops. She was admitted at 31 weeks for re-accumulation of left-sided pleural effusion and administration of rescue corticosteroids. At 32 weeks the fetus was again noted to have fetal hydrops and delivery was recommended. A primary LTCS was performed due to nonreassuring fetal heart tones. Patient delivered a female fetus weighing 1845 gram with APGARS of 2/7. The neonate spent 25 days in NICU with no evidence of pulmonary hypoplasia and was discharged home in stable condition. There was no identified etiology for hydrops and neonate was thriving at 6 week postpartum visit. CONCLUSION: Fetal intervention in a severe case of fetal hydrops can lead to an excellent neonatal outcome. Placement of thoracoamniotic shunts allowed for fetal lung development in setting of severe pleural effusions and allowed an additional 6 weeks of intrauterine growth.