Fetal Pleural Effusion

When fluid builds in the chest of a baby, it is called fetal pleural effusion or fetal hydrothorax. The fluid, located in the chest cavity on the outside of the lungs, can compress the baby’s developing organs. The more fluid that collects in the baby’s chest, the less room there is for the heart and lungs to develop.

About fetal pleural effusion

Fetal pleural effusion can cause damage to the development and function of the heart and lungs. Fluid can cause the heart to shift in the chest and make it difficult to pump blood, leading to fetal heart failure, also called hydrops.

Fetal heart failure can cause fluid to collect in parts of the body like the abdomen (ascites) or build throughout the body (edema). When the lungs do not have the space needed to develop, the lungs do not provide good oxygen exchange at birth. This poor lung development is called pulmonary hypoplasia.

As soon as a baby with a fetal pleural effusion is delivered, the primary concern is how well they can breathe. Babies with breathing problems may be placed on a ventilator or other breathing devices until their lungs improve and they can breathe on their own. In the most severe cases, fetal pleural effusions can lead to a baby’s death during pregnancy.

Evaluation and diagnosis

Fetal pleural effusions can be diagnosed during pregnancy in a prenatal ultrasound. Before your baby is born, the Fetal Center will evaluate your baby’s condition. Your doctor may order additional tests to get more information, such as:

Fetal pleural effusion is very rare and occurs in less than 1% of pregnancies. It can be caused by:

Infection
Anemia
Fetal genetic conditions
Fetal anomalies, such as congenital heart disease
Abnormal blood vessel or lymphatic development

Monitoring fetal pleural effusions during pregnancy

During your pregnancy, you may have regularly scheduled ultrasounds to closely monitor the fluid and your baby’s condition. Fetal echocardiograms can monitor the function of the baby’s heart. In rare cases, the pleural effusion may start to cause health problems for your baby such as lung or heart problems, your doctor may recommend a treatment during pregnancy while the fetus is still in the womb.

Treatments

Fetal thoracentesis is a procedure where fluid is removed from the baby’s chest so that the lungs and heart have room to grow. During the procedure, doctors use an ultrasound to see inside the womb. A small needle is inserted through the mother’s abdomen into the baby’s chest. While the needle is in the womb, a sample of amniotic fluid is obtained. Both fluid samples are tested to find the underlying cause.

In some cases, when the fluid is drained, it does not appear again. In cases where it reappears, doctors may recommend a shunt.

Fetal thoracoamniotic shunt can provide continuous drainage of fluid collected in the chest cavity. This prevents fluid from continually building up and optimizes heart and lung function. This tube will help the fluid move from inside of your baby out to the amniotic fluid surrounding them.

A thoracoamniotic shunt is a small, flexible, plastic tube that is placed in your baby’s chest during pregnancy. One end of the shunt (tube) goes into the baby’s chest cavity and the other end remains in the amniotic fluid in the uterus. The tube will help the fluid move from inside of your baby’s chest out to the amniotic fluid surrounding them. The shunt will remain in place until after the baby is born.

Delivery after shunt placement

For the remainder of your pregnancy, you may have regularly scheduled ultrasounds to check your baby’s condition and ensure that the fluid is not recollecting in the chest. After fetal surgery, you may be able to receive ongoing pregnancy care at your local doctor. The Fetal Center will remain in close contact with your doctor to follow your health, address any issues or questions and provide care as needed.

If your baby has had thoracoamniotic shunt placed, it may not affect how you decide to deliver. You may be able to choose a vaginal delivery as long as there are no severe fetal or maternal conditions that impact the decision. Due to the need for specialized care for your baby at birth, your baby will be born in the Riley Maternity Tower where our team of specialists will be ready to care for you and your baby.

Following delivery, your baby will be cared for in the Neonatal Intensive Care Unit (NICU). If needed, your baby will have access to the most comprehensive Level IV neonatal care and specialty services available. This ensures that you and your baby can stay together after delivery.

Your baby’s breathing will be monitored carefully and supported as needed. This may include putting the baby on a ventilator. Doctors may order additional tests to determine the cause of the pleural effusion such as specialized imaging, testing a sample of the fluid and blood tests. It is possible that the pleural effusion will need to continue to need a tube to help drain the fluid out of your baby’s chest. This type of drain is called a chest tube and works like a thoracoamniotic shunt did during pregnancy.

Your baby’s length of stay in the hospital may depend on how their heart and lungs may have been impacted by the pleural effusion. Your doctors can discuss this and any questions you may have before delivery.

Future pregnancies: Having a fetal thoracoamniotic shunt placed should not impact your future pregnancies.

Key Points to Remember

When fluid builds in the chest of a baby, it is called fetal pleural effusion or fetal hydrothorax.
Fetal pleural effusion can cause damage to the development and function of the heart and lungs.
Fetal pleural effusions can be diagnosed during pregnancy in a prenatal ultrasound.
Fetal pleural effusion is very rare and occurs in less than 1% of pregnancies.
A thoracoamniotic shunt is a small, flexible, plastic tube that is placed in your baby’s chest during pregnancy. The tube will help the fluid move from inside of your baby’s chest out to the amniotic fluid surrounding them.
Your baby’s length of stay in the hospital may depend on how their heart and lungs may have been impacted by the pleural effusion.

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.