What is a hydrothorax?
Hydrothorax (what means water-filled chest) is characterized by an accumulation of fluid in one or both chest cavities.
How is the diagnosis made?
The diagnosis is made by ultrasound. Fluid is found in the thoracic area of the affected fetus. The lungs and other organs of the thorax are compressed as a result.
What is the prognosis of the child with hydrothorax?
The prognosis depends on the cause and severity of the hydrothorax.
A genetic cause, combination with generalized hydrops fetalis, or fetal infection significantly worsen the neonatal outcome. Patients are often offered human genetic analysis.
Marked bilateral hydrothorax may lead to underdevelopment of the lungs (pulmonary hypoplasia).
In some cases, spontaneous disappearance of the hydrothorax has been observed.
How is shunt implantation performed?
Shunt implantation is performed during ultrasound examination under sterile conditions.
Local anesthesia is applied to the abdominal wall beforehand. Puncture of the fetal thorax is performed with a 1.2 mm diameter puncture needle. In some cases, a pig-tail catheter is implanted into the thoracic cavity.
When can shunt implantation be performed?
Shunt implantation can be performed from 16+0 SSW.
What are the complications?
The complication rate is very low with experienced fetal surgeons.
The most common complications are shunt dislocation and premature rupture of membranes.
Other complications such as hemorrhage, injury, or infection are very rare (<1%).
In case of shunt dislocation, re-implantation is offered if necessary.
After shunt insertion, an ultrasound check is performed. This will check the following:
- Shunt position
- Fetal heart rate (by Doppler ultrasound)
- Amount of amniotic fluid
- Exclusion of a complication
