Hydrothorax treated in utero and monitored by fetal echocardiography

Primary fetal hydrothorax is a relatively rare disorder, occurring in 1 out of 15,000 pregnancies, but connected with high perinatal mortality. In the event of little or no progress of the effusion or stable clinical course, conservative management seems to be the most appropriate course of action. In nearly half of the cases, a placement of only one pleuroamniotic shunt enables a total regression of the primary fetal hydrothorax and, consequently, a favourable outcome. The remaining cases require the placement of yet another shunt. In the case of repeated shunt failure, the prognosis is very poor. In the following paper we have presented a fetus with a giant re-accumulating hydrothorax after thoracocentesis, treated by pleuroamniotic shunts and monitored by fetal echocardiography and cardiovascular profile score. Despite dramatic fetal presentation and rapid re-accumulation of the hydrothorax, monitoring by fetal echocardiography and cardiovascular profile score proved the repeated fetal needling and double shunting to be safe. If there are no complications such as premature rupture of the membranes and preterm delivery, fetal echocardiography is a sufficient way of monitoring fetal well-being and the results of intrauterine procedures.