R. Mon1,2, G. Mychaliska1,2, D. Berman2, M. C. Treadwell2, J. Kreutzman1,2, E. Perrone1,2 1University Of Michigan,Pediatric Surgery,Ann Arbor, MI, USA 2University Of Michigan,Fetal Diagnosis And Treatment Center,Ann Arbor, MI, USA
Introduction:
Primary hydrothorax is a congenital anomaly affecting 1 in 10,000-15,000 pregnancies. The associated pulmonary hypoplasia also increases perinatal morbidity and mortality. We reviewed our experience with prenatal management of fetuses diagnosed with primary hydrothorax
Methods:
We retrospectively reviewed the records of patients evaluated for prenatally diagnosed hydrothorax in our Fetal Diagnosis and Treatment Center between 2006 and 2016. We excluded fetuses with cardiac or chromosomal abnormalities, structural anomalies, infections and those cases undergoing termination of pregnancy.
Results:
Pleural effusions were identified in 175 patients. Primary hydrothorax was identified in 9.7%(17/175), and was bilateral in 70%(12/17). Of these patients, 94%(16/17) underwent prenatal interventions. Mean gestational age at the time of prenatal intervention was 27±3.7 weeks. One fetus had intrauterine demise prior to any fetal intervention. Overall, 76% (13/17) had hydrops at presentation. The four patients that did not have hydrops underwent thoracentesis with no re-accumulation requiring further intervention. Of the patients with hydrops, 84% (11/13) chose to undergo shunt placement. One patient with hydrops presented in labor at 29 weeks and underwent thoracentesis preceding Cesarean delivery. The other patient with hydrops presented at 30 4/7 weeks and underwent thoracentesis. The pleural fluid re-accumulated and she delivered 3 days later with another thoracentesis preceding delivery prior to any shunt placement.
Shunt complications were seen in 66%(7/11), including dislodgement and obstruction. These 7 patients underwent repeat shunt placement; one patient had 4 shunts placed in total. Follow up data was available for 68%(11/16) of patients, ranging from 1 to 19 months. All of these 11 patients were live born. Post-natal intervention was required in 63% (7/11). Conservative treatment (chest tube, NPO, ± Octreotide) was efficacious in 71% (5/7). A thoracotomy with pleurectomy was required in 29% (2/7). Of these patients, 72% (8/11) survived to discharge. Complications associated with pulmonary hypoplasia accounted for death in 28% (3/11). There were no immediate or long term maternal or fetal complications from fetal treatment identified.
Conclusion:
This data suggests that fetal intervention for the treatment of fetal hydrothorax is safe and effective. Compared to historical controls, fetal treatment appears to confer a survival advantage, particularly in the setting of hydrops. Shunt complications remain an unsolved problem.