F109The management and outcome of fetal hydrothorax in Taiwan

Background To evaluate the outcome and management of the complications encountered in the cases of fetal hydrothorax. Method 14 cases of fetal hydrothorax were enrolled. Complete prenatal work‐up were done. Thoracocentesis were performed 24–48 h prior to the thoracoamniotic shunting (T‐A shunt). Thoracoamniotic shunting was performed when (i) the age of diagnosis was less than 34 weeks (ii) presence of hydrops fetalis (iii) progression of pleural effusion even after thoracocentesis. Results Among the 14 cases, 10 cases received T‐A shunts with 1 case technically failed to insert who subsequently had distress and demised. The remaining 9 cases (except a case of trisomy 21 & a case of persistent hydrops) had resolved hydrops and pleural effusion after the shunting and survive with good neonatal outcome although 5/8 had preterm delivery. For the 4 cases who did not receive T‐A shunt, only one had pulmonary and gastroenterology sequales. The major underlying cause of effusion was chylothorax. There were 2 dislodged shunts into fetal pleural cavity which had to be removed postnatally. Conclusion The thoracoamniotic shunting is an potentially corrective and effective method for the chronic drainage of massive fetal pleural effusion by reversal of hydrops and prevention of pulmonary hypoplasia. Conservative managements are preserved for the slow‐accumulating pleural effusion, nonhydropic circumstances.