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Re: ChylothoraxFrom: T-H Bui, Clinical Genetics, Karolinska Hospital (bui@gen.ks.se)Thu Jun 20 03:59:46 1996
At 06.42 1996-06-19 -0500, Ira Mark Bernstein wrote: >>Does anybody have any data, formal or informal on drainage of bilateral >>fetal chylothorax, either by serial thoracocentesis or shunt placement. The >>gestation is currently at 19 weeks, normal karyotype. > >Hagay et al Isolated fetal pleural effusion: A prenatal management dilemma. >Obstet Gynecol 1993; 81:147-152. > >A review of the area demonstrating poor outcomes and no evidence of >significant improvement with in utero drainage. >IRA The need for intervention in cases of fetal pleural effusions has been challanged in numerous papers. Although the case under discussion may prove to be chylothorax, this cannot be shown with certainty prenatally by any methods. Hagay et al. (cited by Ira) and Weber and Philipson (Fetal pleural effusion: A review and meta-analysis for prognostic indicators. Obstet Gynecol 1992;79:281-286) came to similar conclusions regarding the factors associated with adversed outcome: nonimmune hydrops, early gestational age at diagnosis, and lung hypoplasia. However, the latter also concluded that intervention improves outcome and should be considered if hydrops develops, particularly at GA <32 weeks. This is our own experience too, and in many leading Centers in Fetal Medicine there is a program for invasive intervention in selected cases. Genetic (chromososome and associated malformations) and infectious etiologies should be ruled out. Isolated unilateral or small bilateral effusions are followed up by repeated U/S. Large bilat hydrothorax (may lead to hydrops) or ealy signs of hydrops are indications for invasive therapy. In your case, there is a chance of transient hydro(chylo)thorax. If the woman is willing to complete the pregnancy, I would first consider intervention after 24 weeks first by thoracocentesis (possibly repeated) to document that the lungs do expand before considering pleuroamniotic shunts. The-Hung Bui, MD Associate Head Director Fetal Diagnosis Program Dept. of Clinical Genetics, Karolinska Hospital, S-171 76 Stockholm, Sweden Consultant Obstetrician-Gynecologist (Fetal Medicine) Dept. of OB&GYN, Huddinge University Hospital, Karolinska Institute, S-141 86 Huddinge, Sweden phone: +46 8 729 4989 (office) or 729 2472 (secretary) fax: +46 8 32 77 34; e-mail: bui@gen.ks.se
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