What is a Pleural Effusion?
The pleural space is the area within each side of the chest where the lungs are located. There are a number of conditions in which fluid may leak out into this space (effusion). This process can apply pressure to and even collapse the lungs. During fetal development, lungs require ample space to grow normally, which is ultimately important to be able to breath at birth. Effusions have the potential to cause mild to severe problems with newborn breathing. With severe effusions, pressure from excess fluid build-up in the chest may also push on important blood vessels and the heart. This may adversely affect the function of the heart and even lead to heart failure, a condition in which fluid may also build up in other body spaces, such as around the heart, in the belly, and inside the skin (hydrops). Hydrops is a life-threatening condition.
Pleural Effusion Causes
Pleural effusions can be diagnosed with prenatal ultrasound in any trimester of pregnancy but are most often seen from the second trimester on. A pleural effusion can occur on its own without any other obvious problems leading to the fluid collection.
However, many conditions can lead to the development of a pleural effusion, including genetic or chromosomal disorders, abnormalities of the heart structure or rhythm, masses that occupy space in the chest, infections, or abnormal function of the lymphatic system.
Outcomes for babies depend on a number of factors, including whether there is a genetic cause and/or other birth defects present. A thorough evaluation of both the mother and fetus is important to help understand the underlying cause for the effusion.
Evaluation in our Fetal Diagnosis and Treatment Center may include:
- Comprehensive ultrasound to look for other abnormalities
- Maternal-fetal medicine consultation
- Consultation with our certified genetic counselors, including a discussion of amniocentesis for karyotype and/or microarray to test fetal chromosomes or additional studies if indicated
- Fetal echocardiogram to assess heart structure, function, and rhythm
Fetal Pleural Effusion Treatment
In some cases, if an effusion is very small, it may be safely observed with close ultrasound follow-up. Sometimes, the fluid collection may even resolve on its own without a fetal therapy intervention. For larger persistent effusions, draining the collection can have a beneficial impact on fetal development. There are two procedures by which we can treat a pleural effusion while you are still pregnant. Both of these procedures remove the extra fluid from the pleural space, allow the lungs to expand and grow, relieve pressure on the heart and its major vessels, and prevent or treat hydrops.
- Thoracentesis: a procedure in which a needle is inserted into the fetal chest and fluid is withdrawn under continuous ultrasound guidance. This may be performed in our Fetal Diagnosis and Treatment Center or on our Labor & Delivery unit to ensure appropriate pregnancy monitoring and maternal comfort.
- Thoracoamniotic Shunt (chest tube) placement: a procedure in which a small plastic tube is placed inside the
baby’s chest wall to drain the excess fluid from the pleural space into the amniotic sac. This is performed under continuous ultrasound guidance in our Labor & Delivery operating room. At times more than one shunt may be needed to drain both the right and left sides of the fetal chest. The shunt is intended to remain in place until the baby is born and is then removed by our neonatologists.
Delivering a Baby with Pleural Effusion
After placement of a thoracoamniotic shunt (chest tube), patients can still have a vaginal delivery. We do recommend delivery at a site where Pediatric Surgery is immediately available. At Michigan Medicine, our Neonatal Intensive Care Unit (NICU) team will immediately evaluate and help your infant in the Newborn Evaluation, Stabilization, and Treatment (NEST) area with Pediatric Surgery available for longer term management. The NEST is conveniently located within Von Voigtlander Women’s Hospital to help support families remaining together. Long-term function of the lungs and/or heart of your baby will depend on how long an effusion existed and whether there are any other birth defects or genetic problems.
Future Pregnancy Risk
Our team-based approach to care provides you and your family the best information and care for your baby and also the risks to future pregnancies. Most pleural effusions do not recur with your next pregnancy. If testing determines that a future pregnancy may be at higher risk for any birth defect or fetal condition, you will be offered consultation with our maternal-fetal medicine and/or genetic counseling team to create a strategy that works best for you and your family.
Make an Appointment
For more information or to schedule an appointment, call 734-763-4264.