Primary fetal pleural effusion: Characteristics, outcomes, and the role of intervention

• Published in: Prenatal diagnosis 2019-05, Vol.39 (6), p.484-488
• Main Authors: Shamshirsaz, Alireza A., Erfani, Hadi, Aalipour, Soroush, Shah, Sohum C., Nassr, Ahmed A., Stewart, Kelsey A., Rezaei, Atefeh, Sanz Cortes, Magdalena, Espinoza, Jimmy, Belfort, Michael A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Diagnosis; Disease Progression; Echocardiography; Edema; Female; Fetal Diseases - diagnosis; Fetal Diseases - epidemiology; Fetal Diseases - therapy; Fetoscopy - statistics & numerical data; Fetus - diagnostic imaging; Fetus - pathology; Fetuses; Humans; Infant; Infant Mortality; Intensive Care Units, Neonatal - statistics & numerical data; Male; Patient Admission - statistics & numerical data; Placement; Pleural effusion; Pleural Effusion - diagnosis; Pleural Effusion - embryology; Pleural Effusion - epidemiology; Pleural Effusion - therapy; Pregnancy; Pregnancy Outcome - epidemiology; Prenatal diagnosis; Prognosis; Retrospective Studies; Treatment Outcome; Ultrasonography, Prenatal; Young Adult
• ISSN: 0197-3851; 1097-0223
• DOI: 10.1002/pd.5462

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. What's already known about this topic? Primary fetal pleural effusions can remain stable, resolve, or progress to fetal hydrops and fetal death. What does this study add? This study reports on the natural history and outcomes of primary fetal pleural effusions based on a recent experience in a single referral fetal center.