Thoracoamniotic shunting for fetal hydrothorax – Predictors of intrauterine course and postnatal outcome

Purpose: To assess predictors for survival and complications among a relatively large cohort of fetuses with hydrothorax treated by thoracoamniotic shunting.

Material and methods: All cases with a prenatal diagnosis of hydrothorax detected in a 10-year period (2002 – 2011) in two tertiary referral centers were reviewed retrospectively for intrauterine course and outcome following thoracoamniotic shunting.

Results: A total of 78 fetuses with hydrothorax treated with thoracoamniotic shunting were included in the study. Mean gestational age at diagnosis was 25.6 weeks (range, 12 – 34 weeks). In 31 (40%) fetuses additional anomalies were found, 13 of them had trisomy 21. Initial thoracoamniotic shunting was performed at a mean gestational age of 26.5 weeks (range, 16 – 33 weeks). A mean of 2.53 shunts (range, 1 – 7) were inserted per fetus. Of the 78 fetuses, 9 (11.5%) died in utero, 69 (88.5%) were born alive and 46 (59%) survived. Prognostic markers significantly associated with non-survival were polyhydramnios, hydrops placentae and mediastinal shift at initial scan, onset of hydrops or lung hypoplasia after first shunt placement, rupture of membranes, a shunt-birth interval < 4 weeks and low gestational age at birth. In our cohort, fetuses with trisomy 21 had a significantly better survival than euploid fetuses. They were diagnosed and treated significantly later in pregnancy, the shunt-birth interval was shorter and the number of interventions was lower than in euploid fetuses.

Conclusions: Although associated with a significant rate of repeated interventions, thoracoamniotic shunting in fetuses with severe hydrothorax might be beneficial and results in an overall survival rate of 59% despite a procedure-related risk of fetal demise of 2/78 (2.5%) cases. Fetuses with hydrothorax and trisomy 21 have a better survival when compared to euploid fetuses.