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This is hydrothorax. Fetal hydrothorax - what is it, consequences, treatment Pleural effusion in fetal hydrothorax

Congenital diaphragmatic hernia (CDH). CDH is an anatomically uncomplicated defect that can be corrected after birth. In this case, the hernial sac is removed from the chest cavity, and the diaphragmatic defect is sutured. However, despite the simplicity of the surgical technique, mortality among this category of patients remains high. Even in the case of the use of extracorporeal membrane oxygenation (ECMO) equipment for CDH, which is diagnosed before 24 weeks of gestation, the death rate of newborns is 58-80%. This is associated with severe hypoplasia of the lung tissue and pulmonary hypertension. Such immaturity is reversible, although it takes weeks or even months. After birth, the time of Ecmo support is limited to 1-2 weeks, respectively, patients with severe pulmonary hypoplasia are doomed. Therefore, in the last decade, intrauterine deficiency correction has found an increasing number of adherents. Numerous animal series have demonstrated that prenatal surgery provides the necessary time for the growth and development of pulmonary parenchyma, whose morphometric parameters differ little from healthy tissue.

The presence of the left lobe of the liver in the chest cavity is the main technical obstacle to correcting the defect, since simply returning it to the abdominal cavity affects blood circulation through the umbilical veins. At the dawn of fetal surgery, there was a popular so-called two-stage operation: removal of the prolapsed hepatic lobe, reconstruction of the diaphragm and mechanical increase in the volume of the abdominal cavity after “re-immersion of the organs”.

However, the subsequent occlusion of the venous duct, which was initially located above the diaphragm, forced us to abandon this technique. Accordingly, determining the thoracic location of the liver part is the most important tactical point. This is decided during either an ultrasound with color mapping (assessment of blood flow through the umbilical veins and ductus venosus), or when scanning in the sagittal plane with an NMR tomograph. The existing diagnostic and treatment algorithm for CDH was developed by the staff of the Center for the Treatment of Fetal Defects at the University of California (San Francisco, USA).

If isolated CDH is detected before 24 weeks of gestation, family members are asked to choose from the following options:

2) give birth to the child at term and continue treatment in the intensive care unit (with an expected favorable prognosis of no more than 58%);

3) try to correct the developmental deficiency prenatally. The recommended algorithm and modern ultrasound parameters help determine treatment tactics.

In the case of the formation of VDH in late gestation, as well as in hypoplasia of the lung parenchyma and minimally displaced organs of the mediastinum and stomach, it is optimal to carry out treatment after the birth of the child. Intrauterine correction is carried out in the presence of the following factors - early formation of intrauterine congestion, significant displacement of the mediastinal organs, an enlarged stomach in the chest cavity, minimally visualized lung tissue, and polyhydramnios.

The search for new surgical approaches to the treatment of VDH ended with the development of a technique for temporary tracheal occlusion (TLPR - pulmonary tamponade until full development). At the same time, by preventing the physiological outflow of fluid from the fetal airways, the pressure in the lung tissue increases, which in turn promotes the expansion of hypoplastic lungs and the return of organs to the abdominal cavity. Described cases of excessive growth of pulmonary parenchyma beyond the boundaries of the diaphragm.

Against this background, trophic factors are simultaneously stimulated. Lung mass increases due to direct hyperplasia rather than hypertrophy. LTLR is performed openly and endoscopically, internally and extraluminally within 24-28 weeks. gestation. The various methods of tracheal occlusion provided are the introduction of an occlusion plug into the cavity, the application of a clip, the installation of a balloon and an umbrella, which change their volume during the growth of the fetus. A comparative analysis of different methods for correcting EDH confirmed the high effectiveness of TLPR. The use of a minimally invasive technique for placing a tracheal obturator reduces the risk of premature birth, which is the Achilles heel of fetal surgery.

Urinary tract obstruction (UTO). There are both unilateral and bilateral weapons of mass destruction. The level of localization varies. In the first case, the prognosis is favorable with regard to the postnatal functioning of not only the urinary system, but also the lungs. Bilateral AMD, especially in combination with oligohydramnios, often leads to the loss of a child in the immediate period after birth. In boys, the posterior urethral valve is usually the cause of bilateral lesions. Girls are characterized by a cloacal anomaly associated with chromosomal defects. Damage to the renal parenchyma ranges from moderate hydronephrosis to severe dysplasia. There has been a clear connection between AMD and lung development. Oligohydramnios, due to critically reduced urine output by the fetus, initiates the processes of hypoplasia of the pulmonary parenchyma. Perinatal mortality due to renal failure, which develops against the background of the posterior urethral valve in the absence of intrauterine correction, reaches 50%. Ultrasound diagnostics in combination with biochemical studies of fetal urine makes it possible to formulate indications for fetal correction of the defect. Renal dysplasia is characterized by increased echogenicity, as well as numerous cysts in the cortical layer of the parenchyma. Renal failure is manifested by high levels of electrolytes and β 2 -microglobulin in the urine. Approximately 75% of all fetuses with dilated genitourinary tracts do not require intrauterine correction. The middle stage of bilateral hydronephrotic transformation of the kidneys without a decrease in the volume of amniotic fluid is corrected mainly after the birth of the child. However, the presence of a tendency to decrease both renal function and the volume of amniotic fluid is the rationale for intrauterine intervention. The main method of intrauterine decompression of the bladder is the subcutaneous installation of a shunt under ultrasound guidance. If such an operation is necessary before the 24th week of gestation, cystostomy is performed using the open method, taking into account the increased risk of premature birth. The technique of fetoscopic transvesical laser sectioning of posterior urethral valves is of increasing interest. A trocar with a thin endoscope, bypassing the wall of the uterus and bladder, enters the lumen of the latter, which makes it possible to assess the condition of the mucous membrane, the place of confluence of the ureters, as well as the localization of the urethral valves. A timely operation aimed at unloading the urinary tract can prevent a decrease in the volume of amniotic fluid and irreversible pulmonary and renal hypoplasia.

Sacrococcygeal teratoma (SCT). CCT is a neoplasm that often occurs during the neonatal period, with a minimal risk of malignancy and a good prognosis. However, the occurrence of pathology in the early stages of gestation (18-20% of the total), especially in combination with generalized fetal edema, leads to its death. This is associated with the development of heart failure against the background of arteriovenous shunting of the tumor. Concomitant maternal mirror syndrome occurs due to placentomegaly and the edema noted above. The goal of intrauterine correction, which is usually carried out at 28-31 weeks, is to stop arteriovenous shunting. During the operation, the area of interest is removed from the uterine cavity. After visualization and isolation of the vascular pedicle, a ligature is applied to it. The tumor is resected as much as possible. In the future, the mother is prescribed continuous use of dexamethasone.

Removal of the CCT, which is comparable in size to the fetal head, provokes a rapid decrease in the size of the uterus. In this case, constant perfusion of warmed Ringer's lactate during surgery allows maintaining a constant volume of amniotic fluid. A sharp change in the working conditions of the fetal heart dictates close echographic monitoring throughout pregnancy. An alternative open method for applying a ligature is fetoscopic coagulation of the feeding vessel. The final removal of the CCT is performed immediately after the birth of the child. Intrauterine surgery leads to the disappearance of fetal edema, but its implementation against the background of placentomegaly and mirror syndrome, which has developed, casts doubt on a favorable prognosis.

Another neoplasm that leads to generalized edema and fetal heart failure is chorionic angioma. Its large size (more than 5-7 cm) emphasizes the arteriovenous shunting expressed in it. The purpose of intrauterine surgery is endoscopic coagulation of vascular anastomoses of the tumor. Complete removal of the latter is carried out as soon as possible after birth.

Myelomeningocele. Neural tube defects are becoming less common, which is associated with the developed method of early α-fetoprotein screening. Since this disease does not pose a threat to life prematurely, the decision on intrauterine correction of the defect is strongly associated with the risk of premature birth. However, the progress of fetal surgery allows us to constantly expand the range of care provided. Since in myelomeningocele the severity of neurological disorders depends, among other things, on the length of the mechanical injury and the effect of the aggressive amniotic environment on the structures of the spinal cord. The operation is performed in the early stages of gestation (20-23 weeks of intrauterine development), since early correction of the defect increases the chance of adequate functioning of the spinal cord. Surgery is performed using both open and endoscopic methods. In the first case, the surgical technique does not differ from that after the birth of the child. During fetoscopic correction, closure of the spinal cord defect is performed using alogenous bone paste.

Stenosis of the Sylvian aqueduct. Obstruction of the outflow of cerebrospinal fluid leads to expansion of the ventricles, compression of brain structures and the subsequent manifestation of neurological disorders. If negative dynamics are already observed in utero, early ventricular decompression allows you to bypass the disorders characteristic of hydrocephalus. Fetal correction involves the subcutaneous installation of a ventriculoamniotic shunt.

Heart block. Most fetuses with a correctly formed heart, but gradually progressive total heart block against the background of collagen-vascular disease in the mother, are born without the need for intrauterine correction. However, in a small proportion, due to bradycardia (heart rate less than 50 per minute), generalized edema may develop with fetal loss. In case of ineffectiveness of β-adrenergic receptor antagonists and steroids, intrauterine implantation of a pacemaker is performed (open or endoscopic).

Stenosis of the pulmonary artery or aorta. Diagnosis of this deficiency does not imply difficulties for echography. The content of the operation is to eliminate the obstacle to the flow of blood through the aortic or pulmonary valve. This is done by subcutaneous balloon dilatation of the narrowed area.

Tracheal stenosis or atresia. A fetus with congenital upper airway obstruction syndrome has large but ineffective lungs. This is due to their overstretching due to fluid that has collected in the respiratory tract. In this case, intrauterine tracheostomy is performed as the first stage of treatment of the malformation.

Disadvantages of facial skull development. It has been proven that wound healing during pregnancy occurs without scar formation. The development of fetal technologies makes it possible to take full advantage of this feature of the fetus. Correction of cleft palate and cleft lip (defects that often occur after birth) is not always accompanied by a satisfactory cosmetic effect. Intrauterine correction of these defects helps to avoid scarring and disruption of the formation of the facial part of the skull and nasal cavity. The results obtained can be regarded as an example for all cosmetic surgery.

Amniotic band syndrome(GLANDERS). FAP is a whole group of fetal malformations that are accompanied by amniotic bands. Early elimination of their contraction effect makes it possible to eliminate limb dysfunctions of varying degrees of severity, as well as their possible intrauterine amputation. The diagnosis is made with a routine ultrasound. The operation is performed fetoscopically at 21-24 weeks of gestation. During such an operation, it is usually sufficient to procoagulate and cut the existing cord. At the same time, visual diagnosis of possible concomitant malformations is carried out. Restoration of blood supply to the extremities is carried out immediately at the completion of the operation. In this case, it is necessary to monitor the complete restoration of its functional ability.

Feto-fetal transfusion syndrome (FTTS) and fetal acardia-acephaly syndrome (FAAS)). In a small percentage of cases during twin pregnancies, the placenta may contain pathological common chorionic vessels. Perinatal mortality in FFTS and FSAA reaches 75%. Exclusion of these vessels from the general blood flow is the goal of intrauterine surgery, which is performed subcutaneously under ultrasound control, endoscopically or openly.

Over the past 20 years, there has been a review of approaches to the treatment of many diseases of newborns that were previously incurable. The development of high diagnostic and surgical technologies, improvement of pregnancy management techniques opens up new opportunities for providing assistance to the child even at the stage of intrauterine development. The further path of fetal surgery is seen in the development and introduction of minimally invasive technologies, the expansion of the spectrum of treatment of diseases and the final result of distribution into narrow-profile areas (thoracic surgery, neurosurgery, etc.), similar to those observed in pediatric surgery.

Hydrothorax is a disease characterized by the accumulation of fluid of various compositions in the pleural area - in the lungs. As a rule, exudate has no connection with inflammation. Hydrothorax is not an independent disease, but a complication of the primary, underlying disease, aggravating its course. It is especially common in the presence of diseases associated with blood stagnation at the level of the pulmonary circulation and high blood pressure.

Hydrothorax can be localized on the left, right, or both sides, with the latter being the most common. Also popular are cases where bilateral hydrothorax develops as a consequence of left- or right-sided hydrothorax. Hydrothorax can be as simple as a collection of lymph (chylothorax) or blood (hemothorax). The volume of liquid can range from 100 milliliters to a liter or more. In cases where the amount of fluid is less than 200 ml, the patient does not feel pain.

Reasons

The disease manifests itself primarily from the point of view of the fact that dynamic accumulation of fluid of a certain composition begins in the pleural area. Thus, the first signs can be recognized when this fluid reaches large volumes and begins to put pressure on the lungs, at the same time displacing organs belonging to the mediastinum area.

Manifestations of the disease are gradual and develop at a smooth pace. The more transudate in the pleura, the more pronounced the signs of hydrothorax. First of all, the expectant mother feels heaviness in the chest area. There may be a feeling of lack of air. At the same time, a woman may complain of an increase in the frequency and depth of breaths. Additionally, you can recognize signs of increased cyanosis - the skin of the expectant mother takes on a bluish tint. This is due to the fact that there is a large amount of carbon dioxide in the patient’s blood, and its removal is difficult.

As a rule, hydrothorax is not characterized by pain in the chest area. If we are talking about large volumes of fluid accumulation, the chest may become deformed. It protrudes, and the upper body of a pregnant woman becomes less mobile. From the point of view of the act of breathing, the affected side lags behind the healthy one. Also, the intercostal spaces disappear on it due to filling with liquid.

When a pregnant patient is in a lying position, she tries to take a position with a raised torso, tilted to the healthy side. Only in this position can a woman breathe normally without experiencing discomfort. If the volume of fluid increases, the patient generally finds the lying position very uncomfortable, and she avoids taking a horizontal position. In some cases, against the background of hydrothorax, a slight increase in body temperature can be detected.

Symptoms

What can cause hydrothorax during early or late pregnancy? Regardless of how this disease manifests itself, doctors identify several causes that can act as provoking factors. So, hydrothorax can be caused by:

decompensation of heart failure;
kidney diseases;
cirrhosis;
myxedema;
large tumor neoplasms located in the mediastinum.

In addition, hydrothorax in expectant mothers, being a non-inflammatory process that occurs with the accumulation of fluids in the pleura, can be a consequence of nutritional dystrophy, in which the body has a deficiency of vitamins B and C. Similarly, the cause of hydrothorax may be hidden in the impossibility of normal outflow lymph.

Diagnosis of hydrothorax in pregnant women

Diagnosing hydrothorax during pregnancy is the task of a pulmonologist. To make an accurate diagnosis, hardware methods (radiography, ultrasound examination, computed tomography) and laboratory tests are used.

From the point of view of radiography, hydrothorax is manifested by darkening of a homogeneous structure, which is localized in the lower parts of the pleura. As the body position changes, the darkening moves freely throughout the pleural area. Likewise, free fluid can be detected during ultrasound examination. At the same time, the ultrasound method allows for the most accurate assessment of the volume of this liquid. As for computed tomography, it allows you to recognize not only the signs of fluid, but also the reasons that provoke its accumulation. For example, CT scan helps detect tumors, enlarged lymph nodes, etc.

The list of laboratory tests includes:

general examination of blood and urine,
blood test for biochemistry,
examination of fluid obtained by puncture,
Rivolta test,
cytology after fluid collection by puncture,
bacteriology.

Complications

Why is hydrothorax dangerous? First of all, there is a high risk of developing acute respiratory failure due to pressure on the lung tissues from accumulated fluid. This greatly aggravates the situation. In addition, there is a possibility of accumulation of pus in the pleura as a result of infection.

Treatment

What can you do

The disease cannot be treated independently without consulting a doctor. Otherwise, there is a risk of missing the moment when hydrothorax can be quickly cured without consequences and independently reducing the chances of a successful recovery.

In order to help the doctor cure hydrothorax, the expectant mother should avoid stressful situations, follow a diet and sleep schedule. In the early stages of pregnancy and the last trimester, in the absence of contraindications, it is recommended to follow therapeutic diet No. 10, limiting the consumption of water and salt.

What does a doctor do

On the part of the doctor, first aid consists of a complex of therapeutic conservative measures and pleural puncture. Drug therapy is aimed at combating the cause of fluid accumulation in the pleural cavity, that is, the underlying disease. If we are talking about large volumes of exudate, puncture is a mandatory procedure. Additionally, after the fluid is collected, it is sent for laboratory testing to confirm the diagnosis.

As a result of the release of fluid from the pleural cavity, respiratory function is restored and blood circulation is normalized. A puncture of this type does not fall into the category of dangerous and complex procedures, therefore, the expectant mother will not have to prepare for the event and fear the risks. The puncture is carried out using a thin needle, and after removing the liquid and needle, the place is sealed with a special sterile bandage.

Patients with diseases associated with the lungs are interested in what hydrothorax is. Transudate is a liquid that begins to accumulate in the body due to disruption of the circulatory or lymph circulation systems; during its formation, no inflammation occurs; its accumulation in the respiratory organs (pleural area) is called hydrothorax of the lungs. Often this is a complication of existing diseases, and not a separate ailment (for example, cancer, pneumonia). In the case when the episode concerns a pregnant woman, such a problem can arise not only in the mother, but also in the fetus.

Hydrothorax, what is it?

It’s worth starting with the fact that a syndrome such as pulmonary hydrothorax has not only individual symptoms, but also has three forms of manifestation, its classification is as follows:

Left-sided hydrothorax;
Right-sided hydrothorax;
Bilateral hydrothorax.

The history of the development of this disease rarely recorded damage to only one lung (especially the left). Most often, it happens that one of the organs begins to suffer (on the left or on the right), and then the disease will spread to the partner organ, acquiring a more familiar form of flow (bilateral).

All types have identical signs, diagnostic methods and treatment.

As mentioned earlier, hydrothorax in the lungs can be caused by dysfunction of different systems, both lymph and blood accumulate in them. This is also usually divided into several groups:

Hemothorax - accumulation of blood;
Chylothorax - accumulation of lymphatic fluid;

Just as with other diseases, disruption of organ function will not be noticeable in the early stages. In this situation, everything depends on the volume of fluid that has managed to accumulate in the lungs; up to the limit of 200 ml, a person usually has no idea about any syndrome. If you do not pay attention to this problem, the total volume of liquid can exceed several liters, which is already very dangerous. If treatment is ignored, hydrothorax can cause many complications, including:

Heart attack;
Kidney failure;
Liver dysfunction;
Swelling of the respiratory system;
Hypoxia (respiratory failure);
Impaired blood circulation.

Usually, such an illness does not pose a mortal danger if you do not delay going to the doctor too much, but this is an indication of another, more serious illness.

Causes of hydrothorax of the lungs

What can cause hydrothorax in the lungs? Medicine has not fully studied this phenomenon and does not know about all the possible roots of the problem. However, some of them are still discovered and proven; this list includes the following diseases:

Renal failure, which accompanies nephrotic syndrome. Hydrothorax of the lungs in this case is provoked by low oncotic pressure;
Myxedema is a deficiency of thyroid hormones. The metabolism of proteins and their absorption in the digestive tract are disrupted, and if you eat foods that do not contain it, there will be complications, often leading to dystrophy;
Hydrothorax of the lungs in oncology manifests itself not so much for physiological reasons, but rather for mechanical ones. The circulation of lymph and blood is disrupted, which increases blood pressure;
Cirrhosis;
Ascites. Pathological accumulation of fluid in the abdominal cavity, which creates excessive pressure and as a result it can leak through the pores into the pleural space, resulting in hydrothorax in the lungs;
According to the same scheme, small hydrothorax can be provoked during peritoneal dialysis. This procedure involves injecting a large volume of fluid into the abdominal cavity and then removing it.
In chronic heart failure (CHF), doctors often detect pulmonary hydrothorax syndrome (hemothorax) of varying severity. Stagnation of blood, which can form in any part of the body, increases hydrostatic pressure and, against the background of this, the fluid passes into the pleural area, this situation in most cases is bilateral in nature. The syndrome has the following symptoms:

Tachycardia;
Shortness of breath;
Night toilet, with a smaller volume;
Attacks of aggression;
Insomnia;
Depression;
General fatigue during the daytime.

In addition to all of the above, the causes of hydrothorax may be:

Various tumors, edema during pregnancy;
Pneumonia;
Ovarian fibroma;
Physical injuries in the chest area;
Anemia;
Pericarditis;
Amyloidosis.

Hydrothorax of the lungs, symptoms

It is worth immediately highlighting two categories of this disease, which are very different from each other and have different symptoms.

Small hydrothorax (up to 150 ml of accumulated fluid). It is a kind of complication of the underlying disease, and not an individual disease;
Total hydrothorax. Such a problem can manifest itself without any precursor diseases;
encysted;

If you do not take into account the symptoms that are characteristic of a particular disease, then this disease has the following general symptoms:

Complaints of chest pain;
Fingers may become swollen;
Dry cough;
Swelling of different parts of the body;
Tachycardia;
Presence of sleep disorders;
Shortness of breath;
Enlarged lymph nodes;
Muscle pain;
Forced pose. It expresses the tilt of the body in the direction where more fluid has accumulated;
Restricted movements;
In severe cases - deformation of the chest (it protrudes forward);

For the most part, such signs only develop over time as the problem begins to become more serious. Having discovered them, you should consult a doctor, and if he diagnoses you with hydrothorax, treatment should be prescribed in a timely manner in order to avoid unpleasant consequences.

When answering the question: “Hydrothorax, what is it?” It is worth noting that, unlike pleurisy, during its course, this disease is not accompanied by inflammation.

Diagnostics

The examination to determine hydrothorax, what it is and what its etiology is, in each specific case includes a certain number of procedures:

X-ray. Problem areas on an x-ray appear as a uniform darkening;
Percussion of the lungs. In this case, the percussion sound will be dull, and above the upper border of the liquid it will be dull tympanic (similar to the sound of a drum);
Puncture of the pleural cavity for hydrothorax is mandatory. This is done in order to determine the nature of the fluid that has accumulated in the respiratory organs.

Important! X-rays will not be useful for mild disease, since the amount of blood or lymph is minimal (100-200 ml).

Ultrasound. Using it, you can determine even the smallest accumulation of fluid (from 10 ml), and also see at what point a pleural puncture will be performed most successfully. Often used in diagnosis during pregnancy;
Computed tomography;

In addition, a number of laboratory tests are taken:

Rivolt's test (distinguishes transudate from inflammatory fluid), in the case of hydrothorax the test is negative;
Blood test;
General urine collection;
Cytology;
Bacteriology;
Study of material obtained through puncture.

Important! This complication is also encountered in gynecology - fetal hydrothorax during pregnancy. The difficulty is that the mother may not have any symptoms or the disease itself. The syndrome can be caused by similar reasons as in an adult body, but it is much more difficult to detect them, especially if the equipment for research is middle class; in this case, an x-ray will definitely not help. Most often, the root of the disease is the heart. Also, there are situations when, due to Rh conflict, the functioning of the circulatory system is disrupted. If the child is newborn, then such a diagnosis can be made due to a entwined umbilical cord or birth injuries.

Treatment of hydrothorax

How to treat this painful condition? It is necessary to understand that treatment with folk remedies in this case can have not only zero effect, but also a huge danger to human health. Help should be provided in a timely manner by the treating specialist.

At the moment, there are various ways to remove excess fluid from the human body, however, in the case of the lungs, such operations involve a puncture in the soft tissues:

Thoracentesis;
Thoracentesis;
Drainage of the pleural cavity (Bülau drainage method);
Puncture with aspiration.

In this way, hydrothorax can only be temporarily alleviated, treatment of which should first of all involve treatment of the underlying disease. Why don’t doctors perform these procedures for any accumulation of transudate? With each subsequent “pumping”, the concentration of protein in the body decreases, and if it does not have time to recover, this is fraught with complications.

However, despite the characteristics of each disease, there are a number of recommendations that must be followed:

Normalize your diet. He should exclude salty foods, coffee, alcohol, and excessive amounts of liquid. A nutritionist can help you balance your diet;
Avoid stressful situations;
For heart problems, split meals are prescribed (5-6 times a day). Medicines used include cardiac glucosides and phosphodiesterase inhibitors (increasing the contractile function of the myocardium). In addition, diuretics are used to remove excess fluid;
Kidney failure can only be cured together with the underlying disease. Bed rest and diet are also recommended;

To prevent hydrothorax, various folk recipes for diuretics are used:

Pour in 0.5 tsp. chopped parsley 500 ml boiling water for 12 hours and drink 1 tbsp. l. before meals;
Birch sap. No more than 2 times a day, 100 ml;
Fresh blackberry, black rowan or serviceberry, take 1 tbsp 3 times a day. l.;
The following herbs are often used:

Birch leaves;
Lingonberry leaves;
Horsetail;
Bearberry;
Orthosiphon.

There are many situations during which hydrothorax of the lungs can occur. For example, with cancer, this occurs quite often and brings additional problems and a deterioration in the general condition of the patient. First aid should be provided by a doctor; if the root cause is treated, then such a complication will go away on its own and will not have time to develop into something more. After therapy, an X-ray examination is prescribed to ensure that the course of treatment was successful and all possible problems were eliminated.

Today I went to the Maternal and Child Health Center. There is no chance of leaving the baby, 3 uzologists looked at us and made the following conclusion: EAP (single umbilical cord artery), double contour of the body, hydrothorax, cystic hygroma of the neck (10mm!!), non-immune hydrocele, reverse blood flow in the ductus venosus, tachycardia... In general, our baby collected everything he could, one question, where did all this come from? My husband and I don’t drink, we don’t smoke, etc.. why? We also performed chorionic villus aspiration, which was not a pleasant procedure, but necessary. According to the blood results, there is a high risk of Down 1/5...

Hyperstimulation

Girls, many people have questions about hyperstimulation, I found a good article, everything is well explained, I think it will be useful to many. Ovarian hyperstimulation syndrome (OHSS) is a fairly extensive complex of pathological changes in the body that occurs during an IVF program (less often with other types of stimulation ovulation in a woman). In this case, there is a significant increase in the size of the ovaries with possible rupture of cysts, specific fluid accumulates in the abdominal cavity (less often, the same effusion forms in the lungs), there may be thrombosis of blood vessels and some other manifestations. It is believed that OHSS occurs more often...

Hydrothorax in the fetus is an accumulation of fluid in the pleural, outer lining of the lungs, caused by malformations or occurring spontaneously. The disease can be dangerous and requires supervision by specialists and sometimes intervention.

Fetal hydrothorax - what is it?

Hydrothorax is an accumulation of fluid in the chest, or more precisely, the pleural cavity of the lungs. The disease can be unilateral or bilateral, as well as a temporary phenomenon that disappears without treatment. Also, the disease sometimes remains at the same level or is accompanied by deterioration. Fluid accumulation leads to decreased lung growth, compression of the heart, and subsequent accumulation of fluid in other parts of the body, such as the abdomen or subcutaneous tissue.

It appears at any stage of pregnancy, starting from 12 weeks, and is diagnosed using ultrasound. This is a relatively rare anomaly, occurring in 1-10 pregnancies out of every 15,000 expectant mothers. If left untreated, the risk of perinatal death in utero or immediately after birth reaches 50%.

Hydrothorax in the fetus - causes

In some cases, this is a single anomaly that is not associated with other manifestations. In other cases, hydrothorax is secondary, that is, it is a symptom of the following disorders:

Down syndrome, Turner syndrome or Noonan syndrome
chest malformations
benign tumor of the pericardium, the membrane that surrounds the heart
infections, hematological diseases.

Sometimes hydrothorax can cause subsequent dropsy or is one of the symptoms of generalized edema (in practice it is more a consequence than a cause) associated with heart failure or Rh incompatibility. An additional symptom is also an increased level of amniotic fluid. Sometimes, the exact cause is impossible to determine.

What to expect and consequences for the fetus

Hydrothorax is usually detected during a routine ultrasound, then the woman is sent to a specialized center, where a more detailed examination is carried out for the presence of malformations. The first step is to try to find the cause of fluid accumulation in the fetal pleura using 3D ultrasound, echocardiography, amniocentesis, infectious and hematological screening of the mother. Based on the information collected and the general situation, the issue of intervention is decided.

The outcome depends on the cause and severity of hydrothorax. If the condition is mild or associated with minimal malformations, the prognosis is generally good, with a survival rate of more than 98% of cases. When the disorder is only one symptom of a serious disorder, the risk of losing the child becomes high. If left untreated, survival rate drops to 20%.

Treatment of hydrothorax in the fetus

The type of medical intervention depends on the situation. At the initial stage, doctors observe the development of the baby, since independent regression is possible, as well as the correct development of the lungs. Immediately before delivery, the need for fluid drainage immediately after birth is assessed.
In the case of hydrothorax associated with generalized dropsy, which occurs in the presence of chromosomal syndrome before the 22nd week of pregnancy, experts suggest considering voluntary termination of pregnancy.

In 5-10% of cases, surgery is used in the form of a drainage catheter to transfer excess fluid from the pleura to the amniotic fluid. Most often, this is practiced when heart failure occurs and the situation generally worsens. The method allows the child to develop correctly until the due date of birth.

The procedure is outpatient - an intervention that usually lasts about half an hour under ultrasound and local anesthesia, and is slightly more serious than amniocentesis. After the procedure, anti-inflammatory and tocolytic drugs are prescribed to prevent uterine contractions. The tube remains in the fetal chest throughout pregnancy and is removed by neonatologists after birth.

Risks after intervention

Intrauterine drainage is not associated with any risk to the mother, but in 10-15% of cases, premature rupture of the membranes occurs at the end of pregnancy. The risk of fetal death is 5-10%.

It should also be emphasized that failures in the procedure are possible, especially in the case of maternal obesity or abnormal fetal position - the catheter simply cannot be installed or it is installed incorrectly. Other reasons are the tube being displaced from its place, as well as its clogging. In these cases, doctors consider deciding whether to try again.

Following the recommendations, being attentive to your own well-being and, of course, having a positive attitude will help you avoid complications after the procedure, because in our modern times, the birth of a healthy child is not uncommon with such disorders.