What is a pleural effusion?
Fetal Lung Lesion Prenatal Care Algorithm
Fetal pleural effusions (also known as fetal hydrothorax) are abnormal accumulations of fluid in the chest cavity. The fluid exists between the lungs and the chest wall and can be on the left, right or both sides. As the fluid increases, it can compress the other structures in the chest such as the lungs and heart. Severe pleural effusions can result in poor development of the lungs or heart failure. Causes of the pleural effusion may include infection, heart conditions, genetic or chromosome problems, abnormal lymph drainage or lung problems but in most cases are unknown.
What will happen during pregnancy?
A pleural effusion is typically diagnosed by ultrasound. If detected, your pregnancy will be closely monitored with ultrasounds to evaluate the severity of the fluid collection and determine if the fetus is any danger.
A specialized ultrasound of the fetal heart, called an echocardiogram, will be performed and an amniocentesis will be recommended to look for chromosomal anomalies.
In some cases, this fluid may spontaneously disappear.
Will a fetal treatment be required?
Most cases of pleural effusion do not require fetal treatment. However, if the fluid accumulates enough to cause severe compression of the heart or lungs, fetal intervention may become necessary. Typically, the fluid in the chest cavity will either be drained once with a small needle, or continuously with a shunt. These procedures are performed with local anesthesia and sedation under ultrasound guidance.
What special considerations should be made for delivery?
Type of delivery - Cesarean delivery is usually not necessary in pregnancies complicated by pleural effusions. The delivery plan should be discussed between you and your obstetrician.
Place of delivery - The baby should be delivered at a hospital that is well prepared to handle the needs and surgery required of infants with a pleural effusion. There should be a neonatal intensive care unit with the capability to provide specialized neonatal intensive care and pediatric surgery services.
Time of delivery - Unless fetal intervention is necessary to address serious complications due to the pleural effusion, there is usually no reason to intentionally induce early delivery and mothers can usually carry the child to term.
What will happen at birth?
Immediately following delivery, doctors will carefully evaluate the baby and begin treatment as necessary. The baby will be stabilized in the neonatal intensive care unit to fully assess the lung and heart function. After delivery, a chest tube may be necessary to help drain the fluid. This will also allow sampling of the fluid to help determine the cause of the pleural effusion. The physicians at the Center will develop a comprehensive plan for you and your baby before, during, and after birth.
What are the long-term outcomes and considerations?
Depending on the severity of the effusion and impairment of lung development, your newborn may have difficulty breathing. Most cases of pleural effusion are mild and children will grow up with normal lung function. Unfortunately, it is difficult to predict the severity of the lung damage based on prenatal ultrasounds or even shortly after birth.
The Center team will help care for you and your infant with a pleural effusion. The Center will develop a comprehensive plan with all of the physicians and specialists involved in the care of you and your newborn.
Contact the Texas Fetal Center to make an appointment with a high-risk pregnancy doctor.
Note: This information regarding your condition is meant to be a helpful, informative introduction. Because every newborn is different, this may not be applicable to all cases, especially if there are additional defects. Your team of experts at the Center will provide you with information specific to your pregnancy.