Successful in utero Percutaneous Fetoscopic Release of a Wrapped Pleuro-Amniotic Shunt around the Fetal Arm: Case Report and Review of the Literature

Background and Objectives: Fetal pleural effusions are either primary or secondary to chromosomal or structural fetal abnormalities. In both cases, thoraco-amniotic shunts may be indicated to prevent life-threatening consequences. In this report, we describe a rare complication of shunts and successful in utero management of this complication. We also summarize the prior reports of shunt wrapping around fetal limbs and successful prenatal release of the shunts. Data Source: Search including PubMed, MEDLINE and EMBASE databases from inception till November 2015 was conducted for cases with shunt entrapment around fetal limbs with or without prenatal management. Results: Four cases including our case have been reported in the literature with wrapping of shunts around fetal limbs. Three of these cases were successfully managed prenatally using different interventional and anesthetic techniques. Conclusions: Prenatal shunts could be rarely complicated by wrapping of the shunt around fetal limbs with possible serious vascular and neurological consequences. Different techniques have been described for prenatal management of this condition. We describe a less invasive approach that could be done under local anesthesia in suitable cases.