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PROGNOSIS OF PLEURAL
FLUID COLLECTIONS |
The outcome of a fetus with a pleural fluid collection depends on the underlying cause of the effusion and the degree of associated pulmonary hypoplasia. The prognosis is good for a fetus with an isolated pleural effusion (no associated hydrops) or an effusion that presents in the latter part of the third trimester. The prognosis is dismal when severe hydropic changes associated structural abnormalities or significant pulmonary hypoplasia is present.
Weber and Philipson (1) reviewed the literature to identify which prognostic indicators are related to outcome. They concluded that the presence of three risk factors indicated the highest predicted probability of poor outcome (97%).
They also found that the highest probability for good outcome to occur was the absence of the three risk factors. This confirmed previous data by Longaker and associates (2).
Parameters associated with a better prognostic include:
1. Later gestational age at diagnosis and delivery.
2. Spontaneous resolution of the effusion prior to delivery.
3. Lack of hydrops.
4. Isolated effusion.
5. Unilateral effusion .
The leading cause of death in neonates is pulmonary hypoplasia.
Weber and Philipson (1) reviewed 124 cases of fetal pleural effusion from 38 reports and found an overall mortality of 46%. Spontaneous resolution of the pleural fluid occurred in 11 fetuses with a 100% survival. Polyhydramnios or bilateral effusions were not associated with a poorer outcome, although hydrops worsened the prognosis. Perinatal survival was 11% for fetuses with pleural effusion who were delivered before 32 weeks gestation, and increased to 61% in fetuses delivered at 32 weeks or more. The overall survival for fetuses with pleural effusion and associated ascites and subcutaneous edema was 41% as opposed to 80% for fetuses in whim pleural effusion was an isolated finding.
Other workers have found that the presence of polyhydramnios is associated with a poorer outcome (3).
Perinatal outcome is strongly related to the uni- or bilaterality
of an effusion (2). Survival with a unilateral effusion was 100% whereas
survival with bilateral effusions was 52%.
The overall mortality of neonates with pleural effusions is 25%, with a
range from 15% in infants with isolated pleural effusions to 95% in those with
gross hydrops. Chromosomal abnormalities, mainly trisomy 21, are found in about
5% of fetuses with apparently isolated pleural effusions.
REFERENCES
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