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Primary fetal pleural effusion: Characteristics, outcomes, and the role of intervention
Alireza A Shamshirsaz1, Hadi Erfani1, Soroush Aalipour1
1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
Insights
Fetal primary pleural effusions (PPE) often resolve or remain stable, leading to favorable outcomes in most cases. This study provides insights for improved patient counseling and care strategies.
Area of Science:
- Perinatology
- Fetal Medicine
- Pediatric Cardiology
Background:
- Fetal primary pleural effusions (PPE) are a rare condition diagnosed prenatally.
- Understanding the natural history and outcomes of PPE is crucial for management.
Purpose of the Study:
- To describe the natural history and outcomes of fetal primary pleural effusions (PPE).
- To provide data for optimizing counseling and care for fetuses with PPE.
Main Methods:
- Retrospective review of fetuses diagnosed with PPE between January 2011 and June 2018.
- Classification of PPE into resolved, stable, or progressive based on fetal echocardiography and hydrops.
- Analysis of interventions and outcomes, including fetal deaths.
Main Results:
- Of 30 fetuses with PPE, 26.7% resolved, 26.7% were stable, and 40.0% were progressive.
- Progressive PPE was associated with interventions like amnioreduction, thoracentesis, and shunt placement.
- Two fetal deaths occurred, both in the progressive group, despite interventions.
Conclusions:
- More than half of fetal PPE cases demonstrate stability or spontaneous resolution.
- Perinatal outcomes for fetal PPE are generally favorable.
- Findings aid in optimizing prenatal counseling and management strategies for fetal PPE.
Background:
We aimed to present the natural history and outcomes of fetal primary pleural effusions (PPE).
Methods:
Fetuses with prenatal diagnosis of PPE delivered between January 2011 and June 2018 were included. Fetal PPE were separated into groups: resolved, stable, or progressive. Progressive PPE was diagnosed, using fetal echocardiography, by the new onset of fetal hydrops or impaired cardiac function. Data were reported as median [range] and n (%).
Results:
Among 189 fetuses with antenatal diagnosis of pleural effusion, 30 had a PPE. A total of 26.7% (n = 8), 26.7% (n = 8), and 40.0% (n = 12) were classified as resolved, stable, and progressive, respectively; two were lost to follow-up. In 14 cases (50%), there were bilateral pleural effusions. Of the 12 cases in the progressive group, four (33.3%) had amnioreduction, six (50.0%) had thoracentesis, and eight (66.7%) had shunt placement performed. There were two fetal deaths, both in the progressive group, one of which received amnioreduction and the other underwent both thoracentesis and shunt placement prior to demise.
Conclusion:
In more than half of fetuses with prenatal PPE, the effusion remained stable or spontaneously resolved, and the perinatal outcomes were generally favorable. This information will be useful in optimizing the counseling and care of these patients.
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