What are the therapeutic strategies for fetal pleural effusions?
The primary treatment is to treat the underlying cause, if possible. Since large pleural effusions can compromise fetal lung development, treatment is warranted. The usual goal, if the effusion is large, is to reduce the volume. If a temporizing treatment is needed (for example, until the therapy for the underlying cause becomes effective), the maternal-fetal medicine physicians may perform an ultrasound-guided fetal thoracentesis. In some instances, this also has a value in determining how rapidly the pleural fluid is accumulating. If, after thoracentesis, the fluid does not reaccumulate, or does so only very slowly, then a longer-term treatment may not be needed. If the effusion reappears quickly, then the maternal-fetal medicine physicians may elect to perform an ultrasound-guided pleuroamniotic shunt placement. These shunts are typically double pigtail in type and are placed using interventional techniques and ultrasound guidance.