Primary 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.

VP52.08: Cardiac output and placental circulation before and after thoracoamniotic shunting in primary fetal hydrothorax

VP52.08: Cardiac output and placental circulation before and after thoracoamniotic shunting in primary fetal hydrothorax

In-utero treatment of prenatal thoracic abnormalities by thoraco-amniotic shunts, short and long term neuro developmental outcome: A single center experience

BackgroundSevere primary fetal hydrothorax (PFH) and fetal lung lesions (FLL) such as congenital pulmonary airway malformation (CPAM) and Bronchopulmonary sequestration (BPS) are often treated by thoraco-amniotic shunt (TAS). ObjectivesTo compare short and long-term outcome of fetuses treated by TAS due to FLL to those treated due to PFH. MethodA retrospective analysis was performed for all fetuses treated by TAS, between the years 2004–2015, evaluating the short and long term neurodevelopmental outcome. Long term neurodevelopment was additionally analyzed prospectively by Vineland adaptive behavioral scale (VABS) standardized questionnaires. Results38 fetuses were treated by 52 TAS insertions; of which 13 (35%) due to FLL and 25 due to PFH. Perinatal survival was high (87.9%) with 3 neonatal death and one termination of pregnancy (TOP). High survival rate persisted even in cases requiring recurrent shunt insertion (80% survival). There was no significant difference in short or long term outcome including perinatal survival (84% Vs 90%, P = 0.64) and hydrops resolution (91% Vs 63%, p = 0.19). Long term outcome, including rate of neurodevelopmental abnormalities (23.5% Vs 20%) and VABS score (91.3 ± 13.3 Vs 96.4 ± 14.7), were similar for both groups. ConclusionTAS insertion is effective and resulting in high perinatal survival even in cases when sequential insertion is needed. Short and long- term outcome of neonates with FLL treated by TAS are comparable to neonates treated due to PFH.

Clinical outcomes of thoracentesis for severe primary fetal pleural effusion.

To investigate the prenatal diagnosis of severe primary fetal hydrothorax and the clinical outcome after intrauterine thoracentesis. A total of 12 patients with severe PFHT and thoracentesis, who were admitted to Xiangya Hospital, Central South University from January 2016 to December 2018, were enrolled. The clinical data were retrospectively analyzed. Five cases were bilateral pleural effusion, 6 on the right side, and 1 on the left side. All cases were accompanied with polyhydramnios, 4 cases with ascites, and 3 cases with skin edema. Ten patients underwent 1 thoracentesis puncture, 1 case for twice, and 1 case for 5 times. Hydrothorax test results of all cases were consistent with primary pleural effusion. Three patients underwent labor induction, 4 of 9 live births had mild asphyxia, 8 required respiratory support, and 7 needed the closed thoracic drainage. All children were fed with medium-chain fatty acid milk powder. Thoracentesis is one of the measures for intrauterine intervention in severe PFHT, which can improve the prognosis of children. Respiratory support, closed thoracic drainage, medium-chain fatty acid feeding are given to newborn. After these treatments, the survival rate is high and the prognosis is good.

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

The prenatal intervention progress of primary fetal hydrothorax

Primary fetal hydrothorax(PFHT) is an uncommon congenital disease.Fetal hydrothorax is thought to be due to leakage of lymphatic fluid in the pleural space either caused by direct leakage of lymphatic fluid from the thoracic duct, overproduction or impaired drainage of lymph.The outcome of fetal hydrothorax may vary from spon-taneous resolution without postnatal morbidity to severe fetal hydrops and perinatal death.At present, there is no consensus on the treatment of PFHT.Now, the latest researches progress on prenatal ultrasonographic characteristics, prenatal diagnostic procedures, prenatal intervention, and prognosis in PFHT, were reviewed combined with the diagnosis and treatment principle of single center in Guangdong Women and Children′s Hospital, which would provide useful guidance for clinical treatment of PFHT. Key words: Fetus; Primary fetal hydrothorax; Prenatal diagnosis; Prenatal intervention

Perinatal outcomes of thoraco-amniotic shunting for severe primary fetal hydrothorax

Objective: To evaluate the safety and perinatal outcomes of thoracoamniotic shunting in the treatment of fetuses with severe primary hydrothorax. Methods: 22 cases of suspected severe primary fetal hydrothorax which underwent thoraco-amniotic shunting in Shanghai First Maternity and Infant Hospital, Fetal Medicine Unit and Prenatal Diagnosis Center from January 2012 to December 2017 were analyzed retrospectively. Hydrothorax associated with structural or chromosomal abnormalities, infections and immune fetal hydrops were excluded. Results: Totally, 28 shunts were placed in 22 fetuses. The median gestational age at TAS was 31.3 weeks. Preterm membrane rupture within 7 days after the procedure occurred in 9.1% (2/22) cases. Catheter displacement occurred in 18% (4/22) cases. The interval from shunting to delivery was 26.0 days. One fetus ended in induced abortion; 21 (95%, 21/22) babies were born alive, and their median gestational age at delivery was 34.4 weeks. 62% (13/21) newborns required ventilator supports; 4 neonatal deaths were attributed to pulmonary hypoplasia. The overall perinatal survival rate was 81% (17/21) . The perinatal survival rate with hydrops and without hydrops were 10/13 and 7/8 respectively. Conclusion: Thoraco-amniotic shunting is a safe procedure for intrauterine therapy and could improve the perinatal outcomes of severe primary fetal hydrothorax.

Outcomes of severe primary fetal hydrothorax treated by prenatal intervention

Objective: To investigate the effect of intrauterine intervention on severe primary fetal hydrothorax. Methods: Twelve cases with severe fetal primary hydrothorax who underwent prenatal intervention from January 2014 to December 2017 in Guangdong Women and Children Hospital were retrospectively reviewed. Results: The median gestational age of prenatal diagnosis was 30.8 weeks (24.0-33.0 weeks) . All cases were excluded congenital chromosomal abnormalities by prenatal diagnosis, and had no complications of pregnancy during prenatal diagnosis and had hydrothorax. Three cases (3/12) were right hydrothorax, the other 9 cases (9/12) were bilateral. Thoracoamniotic shunting was performed in 7 cases (7/12) . Thoracentesis was performed in 5 cases (5/12) , and the hydrothorax reappeared soon after operation in 4 cases, shunt placement was performed again. The hydrothorax was dissolved in 2 cases, released in 6 cases.Tube falling off occurred in 1 case,treatment was abandoned in 1 case and intrauterine fetal death happened in 1 case, and 1 case wasn't rechecked by ultrasonic due to premature birth following thoracentesis. In 10 cases who had deliveries, 5 newborns (5/10) were premature, 6 newborns (6/10) underwent assisted mechanical ventilation, 8 newborns (8/10) underwent thoracic close drainage, all of them were discharged when hydrothorax resolved. Conclusions: Antenatal intervention may improve the chance of survival in severe primary fetal hydrothorax. Thoracoamniotic shunting is the first-choice for the primary severe fetal hydrothorax.

Fetal lung size after thoracoamniotic shunting reflects survival in primary fetal hydrothorax with hydrops.

To assess the role of lung size and abnormal Doppler findings in the umbilical artery (UA) in determining the outcomes of fetuses with primary fetal hydrothorax (FHT) associated with hydrops who underwent thoracoamniotic shunting (TAS). This was a retrospective study at a single center. We included cases of primary FHT with hydrops who underwent TAS at our hospital between 2004 and 2016. We assessed the relationship between mortality until 28 days after birth and ultrasound findings, including absent or reversed end-diastolic velocity (AREDV) in the UA and the lung-to-thorax transverse area ratio (LTR), before and after TAS. Forty-one cases of primary FHT with hydrops underwent TAS. The median (range) gestational age at TAS was 28.5 (19.3-33.8) weeks. Bilateral pleural effusion was observed in 39 cases (95.1%). Among the 41 cases, 19 (46.4%) survived, 11 (26.8%) died in utero, and 11 (26.8%) died in the neonatal period. AREDV in the UA before and after TAS were not associated with mortality (P = 0.32 and 0.47, respectively). The odds ratio for mortality in LTR 0.2-0.3 before TAS was 0.62 (vs LTR < 0.2, P = 0.45) and that in LTR 0.2-0.3 and > 0.3 after TAS were 0.27 and 0.06, respectively (vs LTR < 0.2, P for trend <0.01). A larger LTR after TAS was significantly associated with a better prognosis in hydropic primary FHT. The fetal lung size after the procedure may be a prognostic factor of primary FHT.

The outcomes and prognostic factors of fetal hydrothorax associated with trisomy 21.

To determine the characteristics, outcomes, and prognostic factors of fetal hydrothorax (FHT) with trisomy 21. A nationwide survey was conducted on FHT fetuses with trisomy 21 delivered after 22 weeks' gestation between January 2007 and December 2011 at perinatal centers. The 91 cases of FHT with trisomy 21 included 28 (30.8%) diagnosed in utero and 63 (69.2%) diagnosed after birth. The natural remission rate was 6.6% (6/91). Thoracoamniotic shunting was performed in 14.3% (13/91) of cases. The survival rates of the hydropic, nonhydropic, and total cases were 47.0% (31/66), 84.0% (21/25), and 57.1% (52/91), respectively. The crude odds ratio for death was 8.2 (p=0.003) for fetuses diagnosed at 26-30weeks of gestational age (vs ≥30weeks), 5.9 (p=0.003) for hydrops, 4.0 (p=0.04) for bilateral pleural effusion, 0.68 (p=0.42) for associated cardiovascular anomalies, and 2.1 (p=0.26) for thoracoamniotic shunting (vs no fetal therapy). The prognosis of FHT with trisomy 21 was not very poor, but it was still worse than that of primary FHT. Hydrops, an early gestational age at the diagnosis and bilateral effusion, but not associated anomalies, were risk factors for death. Fetal therapy showed no survival benefit for FHT with trisomy 21. © 2017 John Wiley & Sons, Ltd.

The prognostic factors and outcomes of primary fetal hydrothorax with the effects of fetal intervention.

This study aims to determine the prognostic factors and outcomes of primary fetal hydrothorax (FHT) and investigate the effects of fetal therapy. A nationwide survey was conducted on fetuses with primary FHT delivered after 22 weeks of gestation between January 2007 and December 2011 at perinatal centers. Among the 287 cases of primary FHT, the survival rates for those with and without hydrops were 58.0% (113/195) and 97.8% (90/92), respectively. The survival rates in the no-therapy, thoracocentesis, and thoracoamniotic shunting (TAS) groups in the hydropic cases and the non-hydropic cases were 59.7% (40/67), 51.5% (35/68), and 63.3% (38/60) and 98.1% (53/54), 96.3% (26/27), and 100% (11/11), respectively. The crude relative risk for death was 2.1 (p = 0.005) for fetuses diagnosed at 26 to 30 weeks of gestational age (vs ≥30 weeks), 2.3 (p = 0.001) for both skin edema and ascites, and 3.1 (p = 0.02) for bilateral pleural effusion. TAS was associated with a significant risk reduction for death in hydropic cases [adjusted relative risk 0.61, p = 0.01 (vs no fetal therapy)]. Hydrops and an early gestational age at diagnosis (<30 weeks of gestation), skin edema with ascites, and bilateral effusion predicted a poor prognosis in primary FHT cases. TAS was associated with a higher survival rate. © 2016 John Wiley & Sons, Ltd.

Fetal pleural effusion and Down syndrome.

Fetal pleural effusion is a rare abnormality that results from accumulation of fluid in the chest cavity. It can be classified as primary fetal hydrothorax and secondary fetal hydrothorax. The underlying causes of pleural effusion are still unknown, and the current treatment strategies are mainly based on symptoms. The prognosis of fetal pleural effusion varies significantly, ranging from spontaneous resolution to perinatal death. Recent advances in prenatal diagnostic methods and treatment such as thoracoamniotic shunting have significantly improved the survival rates for patients with or without hydrops.

EP21.16: Prognostic values of Doppler findings in primary fetal hydrothorax around thoracoamniotic shunting

EP21.16: Prognostic values of Doppler findings in primary fetal hydrothorax around thoracoamniotic shunting

Treatment of Primary Fetal Hydrothorax with OK-432 (Picibanil): Outcome in 14 Fetuses and a Review of the Literature

Background: Primary fetal hydrothorax (PFHT) is an uncommon condition with an estimated prevalence of 1 in 10,000/15,000 pregnancies. Therapeutic interventions include thoracocentesis, thoraco-amniotic shunting (TAS), and pleurodesis using OK-432. Methods: A review of the literature was performed to identify all cases of PFHT treated with TAS and OK-432. All cases of PFHT referred to the Fetal Maternal Unit at Royal Prince Alfred Hospital between 2002 and 2012 were retrospectively reviewed. In the cohort of fetuses treated with OK-432, the main perinatal outcomes evaluated were termination of pregnancy, live birth, neonatal death, and fetal death in utero. Secondary outcomes included gestational age (GA) at diagnosis, GA at treatment, GA at resolution, birth weight, and GA at birth. The development of the children was screened using the Ages and Stages Questionnaires, Version 3 (ASQ-3, 2009). Results: Primary hydrothorax was diagnosed in 31 fetuses, of which 14 had treatment with OK-432. One pregnancy terminated after treatment with OK-432. Survival was 85% (11/13): 100% in fetuses treated with OK-432 without hydrops, and 78% in those treated with hydrops. This compares well to the cases of TAS in the literature with an average survival of 63%: 85% in fetuses without hydrops and 55% with hydrops. The mean GA at birth was 36⁺⁴ weeks and mean birth weight 3,007 g. Eight of the 9 children screened with ASQ-3 scored well within the normal range. Conclusion: OK-432 appears to be a valid treatment option in fetuses with PFHT, particularly in those diagnosed at early GAs.

Prenatal management and thoracoamniotic shunting in primary fetal pleural effusions: a single centre experience

Primary fetal pleural effusions are rare. If severe, thoracoamniotic shunting is needed. Our objective was to study the management and outcomes of pleural effusions in our unit. Retrospective analysis of primary fetal hydrothorax between 1991 and 2010. Of 41 cases, 23 (56%) were hydropic, and 27 (66%) required shunting. Overall, 2 (4.8%) were diagnosed with a chromosomal condition and 4 (9.6%) with a congenital condition (3 Noonan syndrome, 1 mild structural cardiac defect). There were 5 terminations of pregnancy (TOP), 3 in utero deaths and 33 liveborn neonates (80%). Intact survival rate was 44% (12/27) among those shunted, 56% (23/41) among all cases and 70% (23/33) among all liveborn neonates. Most (87.5%) neonatal deaths occurred in newborns delivered before 34 weeks of gestation. The survival rate was higher in nonhydropic compared with hydropic fetuses (85% vs 47%). There were no procedure-related fetal losses. One in utero death was complicated by fatal maternal amniotic embolism. Fetuses with pleural effusions should undergo expert prenatal workup. Hydropic fetuses and those with massive effusions are candidates for thoracoamniotic shunting.

P30.22: Spontaneously resolving primary fetal hydrothorax

P30.22: Spontaneously resolving primary fetal hydrothorax

Prenatal therapy for primary fetal hydrothorax in a dichorionic twin pregnancy

Prenatal DiagnosisVolume 26, Issue 6 p. 584-586 Letter to the Editor Prenatal therapy for primary fetal hydrothorax in a dichorionic twin pregnancy Tim Van Mieghem, Corresponding Author Tim Van Mieghem Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, BelgiumDepartment of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, BelgiumSearch for more papers by this authorLiesbeth Lewi, Liesbeth Lewi Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, BelgiumSearch for more papers by this authorDominique Van Schoubroeck, Dominique Van Schoubroeck Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, BelgiumSearch for more papers by this authorDick Oepkes, Dick Oepkes Department of Obstetrics, Leiden University Medical Centre, Leiden, The NetherlandsSearch for more papers by this authorKris De Boeck, Kris De Boeck Department of Pediatrics, University Hospitals Leuven, Leuven, BelgiumSearch for more papers by this authorRoland Devlieger, Roland Devlieger Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, BelgiumSearch for more papers by this author Tim Van Mieghem, Corresponding Author Tim Van Mieghem Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, BelgiumDepartment of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, BelgiumSearch for more papers by this authorLiesbeth Lewi, Liesbeth Lewi Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, BelgiumSearch for more papers by this authorDominique Van Schoubroeck, Dominique Van Schoubroeck Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, BelgiumSearch for more papers by this authorDick Oepkes, Dick Oepkes Department of Obstetrics, Leiden University Medical Centre, Leiden, The NetherlandsSearch for more papers by this authorKris De Boeck, Kris De Boeck Department of Pediatrics, University Hospitals Leuven, Leuven, BelgiumSearch for more papers by this authorRoland Devlieger, Roland Devlieger Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, BelgiumSearch for more papers by this author First published: 01 June 2006 https://doi.org/10.1002/pd.1458Citations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume26, Issue6June 2006Pages 584-586 RelatedInformation

Natural history and outcome following fetal therapy in cases of primary fetal hydrothorax

Natural history and outcome following fetal therapy in cases of primary fetal hydrothorax

Successful treatment of primary fetal hydrothorax with hydrops by pleuroamniotic shunt placement

We treated a case of primary fetal hydrothorax with hydrops. A pleuroamniotic shunt catheter inserted at 30 weeks accomplished resolution of hydrops and was maintained until cesarean delivery at 34 weeks with no need for further prenatal intervention. At age 9 months, the infant showed no effusion or pulmonary compromise.

Pleural drainage in the management of primary fetal hydrothorax (+/− hydrops)

Pleural drainage in the management of primary fetal hydrothorax (+/− hydrops)