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Am J Perinatol 2022; 39(13): 1405-1409
DOI: 10.1055/s-0040-1721689
Original Article

Prenatal and Postnatal Management of Intrauterine Pleural Effusions Associated with Nonimmune Hydrops Fetalis

Hatice S.Y. Cömert 
1   Department of Pediatric Surgery, Karadeniz Technical University, Trabzon, Turkey
,
Şebnem Kader
2   Neonatal Intensive Care Unit, Karadeniz Technical University, Trabzon, Turkey
,
Mehmet A. Osmanağaoğlu
3   Department of Obstetrics and Gynecology, Karadeniz Technical University, Trabzon, Turkey
,
Dilan A. Ural
4   Department of Pediatric Surgery, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
,
Ömer F. Yaşar
1   Department of Pediatric Surgery, Karadeniz Technical University, Trabzon, Turkey
,
Mustafa İmamoğlu
1   Department of Pediatric Surgery, Karadeniz Technical University, Trabzon, Turkey
,
Mehmet Mutlu
2   Neonatal Intensive Care Unit, Karadeniz Technical University, Trabzon, Turkey
,
Haluk Sarıhan
1   Department of Pediatric Surgery, Karadeniz Technical University, Trabzon, Turkey
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Abstract

Objective Nonimmune hydrops fetalis (NIHF) is defined as the accumulation of excess fluid in two or more body cavities in the fetus without blood incompatibility between mother and baby. We aimed to present our prenatal and postnatal management of intrauterine pleural effusions associated with NIHF.

Study Design A total of 60 patients diagnosed with NIHF with intrauterine pleural effusion were analyzed retrospectively. Gestational age of delivery or fetal demise, the intrauterine treatment procedure including extrauterine intrapartum treatment (EXIT), chest tube, and medical treatment methods in fetuses with chylothorax analyzed.

Results Thirty-nine patients (65%) were born alive between 26 and 38 weeks. A thoracoamniotic shunt was placed in one patient during the intrauterine period. Seven patients were placed bilaterally during the postnatal period, all without the umbilical cord being clamped during delivery. But 25 patients died within the first few days following birth. A total of four patients had chylothorax. Two patients who did not respond to medical treatment (somatostatin) were injected with thoracic local batticon and cured. A total of 14 patients were discharged with healing.

Conclusion Cases of progressive prenatal pleural effusions associated with NIHF have a high risk for fetal and neonatal death. We think that extreme prematurity increases postnatal mortality because it negatively affects the development of the lung and heart. A close obstetric follow-up and a multidisciplinary approach are required for the management to be selected.

Keywords

nonimmune hydrops fetalis - intrauterine pleural effusions - batticon - EXIT procedure


Publication History

Received: 26 August 2020

Accepted: 02 November 2020

Article published online:
15 December 2020

© 2020. Thieme. All rights reserved.

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