Cases Of Fetal Hydrothorax Research Articles

Case Report: Pregnancy with Fetal Hydrathorax

Background: Cases of fetal hydrothorax (FHT) are rare, with an occurrence probability of 1 in every 10,000-15,000 pregnancies. The condition may remain undiagnosed, and the fetus may be aborted, or death may occur soon after birth in outlying hospitals before transfer to a tertiary care center. The incidence rate of FHT is higher in males than females (2:1). One of the most effective methods of diagnosing fetal hydrothorax is sonography. Three forms of currently available treatments are: thoracentesis, thoracoamniotic shunting (TAS), and thoracomaternal cutaneous drainage. Fetal outcomes could be improved by performing the Extrauterine Intrapartum Treatment (EXIT) procedure.Case Presentation: We present two cases of first pregnancy primary FHT. In the first case, a 24-year-old woman was diagnosed with asymptomatic FHT in the 28th week of gestation without any prior history. In the second case, a 22-year-old woman with poor medical history was diagnosed in the 35th week of pregnancy and was experienced difficulty of breathing. Both pregnancies were delivered by cesarean section based on obstetric indications. Thoracentesis was performed on both neonates, and pathological examination of the pleural fluid was conducted. However, they died shortly after birth.Conclusion: The EXIT procedure is still a challenging method. A fetus with FHT is at significant risk of pulmonary hypoplasia and respiratory distress following delivery. Early diagnosis and intervention of FHT are vital to ensure a good prognosis. Approaching multidisciplinary groups, providing supportive diagnostic facilities and financial support is essential in improving fetal outcomes and preventing FHT in subsequent pregnancies.

Perinatal outcome of 71 cases of primary fetal pleural effusion

Objective To explore the perinatal outcome of antenatally diagnosed primary fetal hydrothorax (FHT), and to provide management experience for FHT. Methods The clinical data of 80 cases with FHT, from January 2014 to February 2018 in Guangdong Women and Children Hospital, were retrospectively analyzed. Results Among 80 cases of FHT, the median age of the pregnant women was 29 years old (24-33 years old), while the median gestational age at diagnosis was 29+ 1 weeks(24-32 weeks), among them, 9 cases were lost to follow-up.Among the other 71 cases, 48 cases(67.6%) developed fetal edema, 44 cases (62.0%) involved bilateral pleural effusion, and 35 cases (49.3%) were associated with polyhydramnios.The rate of thoracoamniotic shunting and thoracentesis were 29.6% (21/71 cases) and 7.0% (5/71 cases), respectively.Among 71 cases of FHT, the overall survival rate was 63.4% (45/71 cases), the rate of termination of pregnancy was 22.5% (16/71 cases), including 2 cases which were chosen for termination of pregnancy after thoracoamniotic shunting due to poor control.Among the 55 continued gestation cases, 7 cases died in uterus, and the survival rate of fetal hydropic cases and non-hydropic cases was 70.6% and 100.0%, respectively, and the difference was statistically significant(P<0.05). Among the 48 cases of hydropic cases, there were 34 cases (70.8%) chosen to continue the pregnancy, the survival rate of non-intervention group (13 cases), thoracentesis group (4 cases) and thoracoamniotic shunting group (17 cases) were 53.8%, 75.0% and 82.4%, respectively, and the difference was statistically significant (P<0.05). Conclusions Fetal hydrops predicted a poor prognosis in PFHT.Timely intrauterine intervention could effectively improve the prognosis of PFHT and improve the survival rate. Key words: Hydrothorax; Uterine intervention; Fetal

F109The management and outcome of fetal hydrothorax in Taiwan

BackgroundTo evaluate the outcome and management of the complications encountered in the cases of fetal hydrothorax.Method14 cases of fetal hydrothorax were enrolled. Complete prenatal work‐up were done. Thoracocentesis were performed 24–48 h prior to the thoracoamniotic shunting (T‐A shunt). Thoracoamniotic shunting was performed when (i) the age of diagnosis was less than 34 weeks (ii) presence of hydrops fetalis (iii) progression of pleural effusion even after thoracocentesis.ResultsAmong the 14 cases, 10 cases received T‐A shunts with 1 case technically failed to insert who subsequently had distress and demised. The remaining 9 cases (except a case of trisomy 21 &amp; a case of persistent hydrops) had resolved hydrops and pleural effusion after the shunting and survive with good neonatal outcome although 5/8 had preterm delivery. For the 4 cases who did not receive T‐A shunt, only one had pulmonary and gastroenterology sequales. The major underlying cause of effusion was chylothorax. There were 2 dislodged shunts into fetal pleural cavity which had to be removed postnatally.ConclusionThe thoracoamniotic shunting is an potentially corrective and effective method for the chronic drainage of massive fetal pleural effusion by reversal of hydrops and prevention of pulmonary hypoplasia. Conservative managements are preserved for the slow‐accumulating pleural effusion, nonhydropic circumstances.