Perinatal outcomes in the fetuses diagnosed with hydrops fetalis and isolated pleural effusion

Hidrops fetalis ve izole plevral effüzyon saptanan fetüslerde perinatal sonuçlar

Abstract

Objective: Our study aims to evaluate our clinical experience on and postnatal outcomes of the cases with primary pleural effusion and hydrops who admitted to our clinic. Methods: In our study, the cases found to have fetal pleural effusion with or without hydrops finding in the second and third trimester between January 2017 and October 2019 were evaluated retrospectively. The patients were examined in terms of the blood types, middle cerebral artery peak systolic velocity and lymphocyte levels in their pleural effusion fluid, and their detailed fetal anatomic screening, fetal echocardiography, karyotyping examination, and TORCH screening in the maternal blood were carried out. Results: Twelve patients who underwent thoracocentesis and 2 patients who did not undergo thoracocentesis were included in the study. It was found that 6 patients had hydrops and 8 patients had isolated pleural effusion. Postnatal diaphragmatic hernia was detected in 1 of the isolated cases, and it was repaired primarily. Thoracocentesis was carried out in 12 patients except 2 patients. When the effusion relapsed in 6 patients after the first thoracocentesis, the procedure was repeated in 2 patients when the labor was close. While postnatal intubation was not necessary in the newborns that underwent the repeated procedure, 4 patients who did not undergo were intubated. Emergency cesarean section was performed upon the development of fetal distress in a fetus during the second procedure. Postnatal thorax tube was placed to 6 patients who had recurrent pleural effusion. One fetus which had hydrops and whose lymphocyte rate was 1–2% in the pleural fluid died in the intrauterine period and two newborns died in the postnatal period. No complication developed in 11 patients during the follow-up period which took about 9 months. Conclusion: Having hydrops fetalis in the presence of fetal pleural effusion and detecting low lymphocyte rate in the pleural fluid affect the prognosis negatively. Performing thoracocentesis in the presence of pleural effusion together with or without hydrops and repeating the procedure when the labor is close have a positive impact on the perinatal outcomes. The families should be recommended intrauterine fetal treatment for the appropriate cases and the labor should be planned in a tertiary center.

Özet

Amaç: Klini¤imize baflvuran primer plevral effüzyon ve hidrops geliflen olgularda klinik deneyimimiz ve postnatal sonuçlar›n de- ¤erlendirilmesidir. Yöntem: Çal›flmada Ocak 2017 – Ekim 2019 tarihleri aras›nda ikinci ve üçüncü dönemde hidrops bulgusu olan veya olmayan fetal plevral effüzyon saptanan olgular retrospektif olarak incelendi. Hastalar kan gruplar›, orta serebral arter pik sistolik velositesi ve plevral effüzyon s›v›s›nda lenfosit düzeyi yönünden incelendi ve hastalar›n ayr›nt›l› fetal anatomik taramas›, fetal ekokardiyografisi, karyotip incelemesi ve maternal kanda TORCH tetkikleri yap› ld›. Bulgular: Çal›flmaya torakosentez uygulanan 12, uygulanmayan 2 hasta al›nd›. 6 hasta hidrops fetalis, 8 hasta izole plevral effüzyon olarak de¤erlendirildi. ‹zole olgular›n 1 tanesinde postnatal diyafram hernisi saptand› ve primer onar›ld›. 2 hasta hariç 12 hastaya torakosentez yap›ld›. Birinci torakosentez sonras› 6 hastada effüzyon tekrar› olmas› üzerine 2 hastaya do¤uma yak›n ifllem tekrar› gerçeklefltirildi. ‹fllem tekrar› yap›lan bebeklerde postnatal entübasyon gerekmezken, yap›lmayan 4 hasta entübe edildi. 2. ifllem s›- ras›nda bir fetüste fetal distres geliflmesi üzerine acil sezaryen ile do¤um yapt›r›ld›. Tekrarlayan plevral effüzyonu olan 6 hastaya postnatal toraks tüpü tak›ld›. Hidrops olan ve plevral s›v›daki lenfosit oran› %1–2 olan bir fetüs intrauterin, iki bebek postnatal dönemde kaybedildi. Ortalama 9 ayl›k izlem sürecinde 11 hastada komplikasyon geliflmedi. Sonuç: Fetal plevral effüzyon varl›¤›nda hidrops fetalis olmas›, plevral s›v›da lenfosit oran›n düflük saptanmas› prognozu olumsuz etkilemektedir. Hidropsla birlikte olan ya da olmayan plevral effüzyon varl›¤›nda torakosentez uygulanmas› ve do¤uma yak›n tekrarlanmas› perinatal sonuçlar üzerine olumlu etkisi olmaktad›r. ‹ntrauterin fetal tedavi uygun olgularda ailelere önerilmeli ve do¤umun 3. basamakta yap›lmas› planlanmal›d›r.