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Outcomes of fetuses with primary hydrothorax that undergo prenatal intervention (prenatal intervention for
Rodrigo A Mon1, Marjorie C Treadwell2, Deborah R Berman2
1Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan; University of Michigan Health System, Fetal Diagnosis and Treatment Center, Ann Arbor, Michigan.
Insights
Prenatal intervention for fetal hydrothorax, a rare congenital anomaly, shows effectiveness in improving survival rates. However, challenges like preterm labor and premature membrane rupture persist, requiring further research.
Area of Science:
- Perinatology
- Fetal Medicine
- Congenital Anomalies
Background:
- Primary hydrothorax is a rare congenital anomaly affecting 1 in 10,000-15,000 pregnancies.
- It can lead to pulmonary hypoplasia, increasing perinatal morbidity and mortality.
- Optimal prenatal intervention strategies remain debated.
Purpose of the Study:
- To evaluate the effectiveness of prenatal interventions for primary fetal hydrothorax.
- To assess survival rates and complications associated with these interventions.
Main Methods:
- Retrospective review of 15 patients diagnosed with primary hydrothorax between 2006-2016.
- Exclusion of cases with secondary causes or elective termination.
- Analysis of prenatal interventions including thoracentesis and shunt placement.
Main Results:
- Primary hydrothorax was diagnosed in 15 patients (8% of fetal pleural effusions).
- Prenatal intervention was performed in all 15 cases, with thoracentesis in 93% and shunt placement in 66%.
- Overall survival was 76%, with significant rates of prematurity (69%) and preterm premature rupture of membranes (35%).
Conclusions:
- Fetal intervention for primary hydrothorax appears effective and confers a survival advantage.
- Procedures were generally well-tolerated by fetuses and mothers.
- Preterm labor and preterm premature rupture of membranes remain significant challenges requiring further investigation.
Background:
Primary hydrothorax is a congenital anomaly affecting 1 in 10,000-15,000 pregnancies. The natural history of this condition is variable with some fetuses having spontaneous resolution and others showing progression. The associated pulmonary hypoplasia leads to increased perinatal morbidity and mortality. Optimal prenatal intervention remains controversial.
Methods:
After obtaining the Institutional Review Board approval, a retrospective review of all patients evaluated for a fetal pleural effusion in the Fetal Diagnosis and Treatment Center at The University of Michigan, between 2006 and 2016 was performed. Cases with secondary etiologies for an effusion or when families decided to pursue elective termination were excluded.
Results:
Pleural effusions were identified in 175 patients. Primary hydrothorax was diagnosed in 15 patients (8%). The effusions were bilateral in 13/15 cases (86%) and 10/15 (66%) had hydrops at presentation. All 15 patients with primary hydrothorax underwent prenatal intervention. Thoracentesis was performed in 14/15 cases (93%). Shunt placement was performed in 10/15 cases (66%). Shunt migration was seen in four patients (40%) and all of these underwent prenatal shunt replacement. Overall survival was 76%. The rates of prematurity and preterm premature rupture of membranes were 69% and 35%, respectively.
Conclusions:
Fetal intervention for the treatment of primary hydrothorax is effective, and it appears to confer a survival advantage. Both the fetuses and the mothers tolerated the procedures well. Preterm labor and preterm premature rupture of membranes remain an unsolved problem. Further studies are needed to understand the mechanisms behind the development of fetal hydrothorax.
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