Intrapartum drainage of fetal pleural effusion

Our objective was to describe our experience with intrapartum thoracocentes is in fetuses with severe bilateral pleural effusion. We describe the outco me of four consecutive cases of fetal pleural effusion due to chylothorax t hat were managed by intrapartum thoracocentesis. These fetuses were not can didates for pleuro-amniotic shunting either because of the need for prompt delivery (three fetuses) or because of advanced gestational age (one fetus) . Thoracocentesis was performed in the operating theatre under ultrasound g uidance prior to Caesarean delivery. Gestational age at the time of diagnos is and thoracocentesis ranged between 26-34 weeks and 31-34 weeks respectiv ely. Bilateral thoracocentesis was performed in two fetuses and unilateral in the remaining two fetuses. All four infants were born in a relatively go od condition however, all eventually required intubation, ventilation and c hest tubes. Chest tubes were introduced between 2 h and 5 days after delive ry in three infants, and immediately after birth in one infant who was hydr opic. Two infants survived and are developing normally. One infant died fro m sepsis following successful pleurodesis and one from aspiration on day 51 . Our conclusions are that intrapartum thoracocentesis seems to be a relati vely simple procedure, that allows newborns with pleural effusion, to breat he spontaneously or be more easily ventilated. This in turn, reduces the ne ed to introduce chest tubes in an emergency situation. Copyright (C) 1999 J ohn Wiley & Sons, Ltd.