Drainage thoraco-amniotique en urgence en cas d'épanchement pleural compressif responsable d'anasarque fœtale: Une série rétrospective de 60 cas

Objectives. To study perinatal outcome following thoraco-amniotic shunting for fetal pleural effusions with hydrops. Matérials and methods. Retrospective study (1984-2004) to evaluate a policy of emergency thracoamniotic shunting in hydropic fetuses with suspected chylothorax, on the basis of the rationale that mediastinal compression could lead to acute fetal distress. Results. Shunting was performed immediately following diagnosis, and was successful in all 60 cases attempted. There were 7 pregnancy terminations, 10 in utero deaths, and 43 live births, of which 7 children died in the neonatal period and 36 survived (33 without sequels). Among the liveborn, 26 were delivered preterm (72%), of which 7 (19%) had preterm premature rupture of membranes and 4 (11%) had chorioamnionitis. Perinatal death (24/60, 40%) was related to underlying anomalies (7 cases), pulmonary hypoplasia (5 cases), chorioamnionitis (2 cases), or treatment failure for unknown reasons (10 cases). All 36 survivors had chylothorax, 33 of which were primary, and 3 were secondary to right congenital diaphragmatic hernia, pulmonary sequestration, or Noonan syndrome. Conclusion. Following shunting, pleural effusion with hydrops has survival rate >50%, but still have a high rate of morbidity and mortality.