Fetal Pleural Effusion Research Articles

Predictive value of pleural effusions in fetal hydrops.

Twenty-eight cases of fetal hydrops are reported. A diverse aetiology was found. Fetal therapy was undertaken in 12 (42.9%). The overall survival rate was 36.8% (excluding elective terminations). However, when normal fetuses presenting from 20 weeks were considered, the survival rate was 64%. The results were combined with those of two other studies (making a total of 182 cases with fetal hydrops) to ascertain the value of pleural effusions in predicting outcome in such cases. In the 143 cases that did not end in a therapeutic termination of pregnancy, fetal pleural effusions predicted death (fetal or neonatal) with a sensitivity of 67%, a specificity of 53%, a positive predictive power of 68%, a negative predictive power of 52% and an overall accuracy of 62%.

Respiratory function in infancy following pleuro-amniotic shunting.

Respiratory status was assessed at a median of 12 (range 3-60) months in 17 infants who had undergone pleuro-amniotic shunting to drain fetal pleural effusions. The shunts had been inserted at a median of 29 weeks (range 21-35) gestation; 12 fetuses were hydropic at the time of shunting. In all 17 cases effective chronic drainage of the pleural effusions was achieved. Respiratory status at follow-up was assessed by documentation of respiratory symptoms and measurement of functional residual capacity (FRC) by a helium gas dilution technique. Six infants suffered from recurrent respiratory symptoms, this incidence (37%) did not differ significantly from that found in a control group. The mean FRC of the study population was 28 ml/kg (range 19-34 ml/kg), only 2 infants' FRCs were below the reference range. These results suggest that pleuro-amniotic shunting may, be effective drainage of pleural effusion and hence prevention of chronic antenatal intrathoracic compression, avoid impairment of antenatal lung growth.

Spontaneous Resolution of Second Trimester Fetal Pleural Effusion

A case of pleural effusion, diagnosed by ultrasound in the second trimester, underwent spontaneous resolution without adverse effect on lung development. Optimal management has not been defined; because the natural history of fetal pleural effusion is unknown, observation with serial ultrasound is an alternative to in utero therapy.

Spontaneous variation in fetal pleural effusions. Case report

Spontaneous variation in fetal pleural effusions. Case report

Spontaneous resolution of fetal pleural effusion diagnosed during the second trimester

Spontaneous resolution of fetal pleural effusion diagnosed during the second trimester

Thoraco-Amniotic Shunting

Thoraco-amniotic shunting was performed in 51 singleton pregnancies for decompression and chronic drainage of fetal pleural effusions (n = 47), pericardial effusion (n = 1), or pulmonary cysts (n = 3). Five fetuses had chromosomal defects and in 4 the parents elected termination of pregnancy. All 18 non-hydropic fetuses and 14 of the 28 with hydrops survived. Thoraco-amniotic shunting is useful for diagnostic evaluation and treatment of fetuses with pathologic collection of intrathoracic fluid.

The sonographic features and implications of fetal pleural effusions

Pleural fluid was detected by ultrasound in three fetuses as an anechoic area surrounding the echogenic fetal lung. In one fetus the underlying lung was small, immobile and of abnormal contour; death occurred in the neonatal period and the lung was found to be hypoplastic. In two other fetuses the lungs appeared sonographically normal, being mobile with normal contours. Both survived, one following spontaneous intra-uterine resolution of the effusion and the other after early neonatal intervention prompted by the antenatal diagnosis. Sonography can detect pleural fluid in utero and may permit differentiation between normal underlying lung and pulmonary hypoplasia. We recommend serial scanning to detect early adverse effects of pleural effusion upon the fetus and to plan management changes.

Nonimmune hydrops fetalis: Clinical experience and factors related to a poor outcome

Twenty-one cases of nonimmune hydrops fetalis diagnosed at the Medical College of Georgia during a 2-year period are presented. All fetuses satisfied strict diagnostic criteria and were evaluated according to a standard protocol. The corrected mortality rate was 95% with pulmonary hypoplasia being the most common cause of perinatal death. The mean gestational age at diagnosis was 24.8 weeks; in 57% of the cases the cause of nonimmune hydrops fetalis was identified. Fifteen fetuses had serial ultrasound assessment and in 19 cases postnatal evaluation was performed. Two factors that consistently conveyed a poor perinatal outcome were ultrasonographic evidence of malformation and/or the presence of persistent pleural effusions. A method for the quantification of fetal pleural effusions is presented and its clinical relevance is discussed.

Spontaneous Resolution of Massive Fetal Pleural Effusion: A Case Report

DOI: http://dx.doi.org/10.3126/njog.v4i2.5050 NJOG 2010 Jan-Feb; 4(2): 56-58