Single Thoracentesis in Unilateral Fetal Hydrothorax: a Case Report

A case with a pleural effusion and hydrops fetalis has been presented. Good outcome had been achieved by a single thoracentesis and a healthy baby w as delivered at the 39th w eek of pregnancy. In a fetus with a pleural effusion and hydrops fetalis, normal like echogenic view of the affected side lung and lung expansion during aspiration without any signs of fetal distress are good prognostic signs. We believe that in such conditions performing a single thoracentesis could be the first choice of treatment, which is a less complicated and traumatic method than thoraco-amniotic shunting. K e y W o rd s : Single thoracentesis, Fetal hydrothorax IN T R O D U C T IO N Prim ary fetal hydrothorax (P F H T ) is fetal intrathoracic effusion that may occur uni-or bilaterally. The incidence of this uncommon disorder is about 1 in 10,000 15,000 pregnancies. It can develop and be associated with a variety of etiologies. Fetal pleural effusion may occur as a part of fetal hydrops and more rarely, as an isolated lesion. Isolated pleural effusion may progress to generalize hydrops; thus, fetal pleural effusion may represent an early stage in the development of nonimmune hydrops and may be more common than appreciated. On the other hand, such an isolated hydrothorax may progress to nonimmune hydrops fetalis (1). The outcome of P FH T is variable and unclear; the evolution can result in spontaneous regression, progress to hydrops and no change with an unpredictable clinical course. Thus, the reported perinatal mortality va ries between 34 ,8% to 100% . The clin ical therapeutic approach is debated and variable. Thoracentesis and pleuroamniotic shunting are the choices of treatment (2,3). Recently, pleuroamniotic shunting seem s to be the first choice of treatment as quick reaccum ulation takes place after a single drainage. Som e authors are in favor of thoracoamniotic shunting, and they find single drainage unsatisfactory to prevent pulmonary hypoplasia, and to reverse hydrops and polyhydramnios (4 ,5). By this case report we tried to d iscuss the conditions where single (Accepted 19 February, 2002) Marmara Medical Journal 2002;15(2):114-118 Correspondance to: Seyfettin Uludağ, M. D, Sub-department ot Perinatology, Department o f Obstetrics and Gynecology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey, e.mail address: [email protected]