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Fetal hydrothorax associated to hydrops: expectant or interventionist management?

Keywords: Hidrotórax fetal , Hidrops fetalis , Derivación pleuroamniotica.

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Abstract:

Background: Fetal hydrothorax is the accumulation of free fluid in pleural cavity offetus. It is very often associated to hydrops fetalis which is a serious entity with ahigh perinatal mortality, multifactorial etiology and it is characterized by generalizedanasarca, with accumulation of fluid in some serous cavities of the fetus. It is importantto know beforehand if this condition is present in order to establish the most probableorigin and to be prepared to administer optimal reanimation management of the neonateat birth. The care given to a newborn with hydrops fetalis is always a challenge for theneonatologist. We present a report of a case in the city of Cartagena. Case report: We present the case of a pregnant woman, O positive blood type, with importantpreceding surgery, without alterations in previous pregnancy. Her fetus in 31st weekwas diagnosed with bilateral pleural effusion. The especialist performed intrauterineintervention to drain fluid twice without improvement, therefore pregnancy wasinterrupted through cesarean section. The newborn presents signs of respiratory failurerequiring mechanical ventilatory assistance with high parameters. The pleural effusionpersisted, so drainage and insert of thoracic tube was made obtaining an unfavorableevolution with neonatal death. Conclusions: Currently, there′s not a world consensusof the management of fetal hydrothorax associated or not to hydrops; we presenthighlights to guide the decision of an expectant or interventionist management, basedon underlying cause.RESUMEN:El hidrotórax fetal es la acumulación de líquido libre en la cavidad pleural fetal. Seasocia muy frecuentemente al hidrops fetalis entidad de elevada mortalidad perinatal,de etiología multifactorial y caracterizado por anasarca generalizada, con acumulaciónde líquido en algunas cavidades serosas del organismo fetal. Es importante establecercon antelación esta condición, ya que debe conocerse la causa más probable, paraayudar en la mejor reanimación al nacimiento. Se presenta el reporte de un casoen la ciudad de Cartagena. Colombia. Paciente de 35 a os de edad, secundigestantede grupo sanguíneo RH positivo, con antecedente quirúrgico de resección de tumordermoide en pared abdominal, músculos rectos abdominales, con colocación de malla depropileno. Embarazo anterior sin alteraciones. A las treinta y una semana de gestaciónse hace diagnóstico ecográfico de derrame pleural bilateral fetal. Se realiza intervenciónintrauterina para drenar líquido y colocación de dren pleuroamniotico. Por no presentarmejoría se decide nuevamente toracocente

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