UCCESSFUL OUTCOME IN FETAL CHYLOTHORAX WITH FETAL THORACOCENTESIS - A CASE REPORT

Abstract

INTRODUCTION The incidence of fetal pleural effusion is 1 in 15,000 pregnancies. This case is reported to stress on the successful fetal outcome after a fetal   intervention of therapeutic thoracocentesis. ABSTRACT 34 yrs Rh negative G2P1L1 post caesarean pregnancy whose LMP was not known with 32 weeks 5 days gestational age (as per 15 wks scan) referred to KMCH as USG showed fetal left pleural effusion and polyhydramnios. Expert USG done showed 34 weeks gestation with polyhydramnios    (AFI -24.6 ), isolated fetal left pleural effusion with mediastinal shift to right with no evidence of fetal anaemia. Under  ultrasound guidance and under local anesthesia, fetal    thoracocentesis was done at 34 weeks 2days. Since fluid was reaccumulating, fetal therapeutic thoracocentesis was planned. At 36 weeks, therapeutic thoracocentesis was done again and aspirated 250-300 ml of straw coloured fluid and sent for analysis. Since re-accumulation was considerable, it was decided to terminate pregnancy soon after the                      therapeutic thoracocentesis. Elective repeat LSCS was done on the same day and Inj anti D 300 microgram IM given. Baby was 3 kg alive late preterm girl of 36 weeks which cried          immediately after birth.6 hrs later baby developed                tachypnoea, subcostal retraction and decreased air entry on the left side.7 hours after birth, ICD done-10 ml haemorrhagic fluid drained. FFP was given. ICD drained 100ml over first 3 days, then 10 mlday for 2 days, finally nil drainage from day 6.ICD removed on day 7. Baby was observed for 23 days for follow up. Inj. Octreotide started and continued for 2 weeks. Higher antibiotics given. MCT oil given for 6 weeks. Serial USG chest showed gradually decreasing pleural effusion with no evidence of pleural effusion after 30 days. Serial Chest X rays showed improving lung expansion with no evidence of effusion after 30 days. Baby was discharged on 30 th day DISCUSSION The goals of fetal intervention are to prevent lung compression allowing normal development of lungs, prevent or reverse hydropic changes and hydramnios  avoiding preterm delivery , fetal death and to improve post natal respiratory function .