Obstetrics & Gynecology · 4 h ago
Meta-analysis reports outcomes after fetal thoracoamniotic shunting
A systematic review and meta-analysis pooled outcomes from 45 studies involving 1,976 fetuses treated with thoracoamniotic shunting for pleural effusion or congenital lung lesions. The authors reported substantial rates of perinatal death, preterm birth and shunt complications, alongside frequent resolution of hydrops in affected fetuses.
- Review included 45 studies and 1,976 fetuses.
- Perinatal death estimates were 29.5% and 22.6%.
- Shunt displacement and malfunction were reported.
- Authors call for standardized criteria and prospective studies.
Researchers searched six databases through November 6, 2025, for studies reporting outcomes after thoracoamniotic shunting (TAS) for fetal pleural effusion or congenital lung lesions. The systematic review included 45 studies and 1,976 fetuses. Single-arm random-effects models were used to estimate pooled outcome proportions; results were stratified by diagnosis.
For pleural effusion, pooled fetal and perinatal death proportions were 8.3% and 29.5%, respectively. For congenital lung lesions, they were 6.6% and 22.6%. Shunt displacement was reported in 13.2% of pleural-effusion cases and 10.2% of lung-lesion cases; obstruction or malfunction occurred in 14.1% and 8.6%, respectively. Preterm prelabor rupture of membranes was reported in 19.3% and 15.4%, while birth before 37 weeks occurred in 64.3% and 41.6%. Among hydropic fetuses, hydrops resolved in 63.3% of pleural-effusion cases and 95.1% of lung-lesion cases.
The authors conclude TAS may contribute to thoracic decompression and resolution of hydrops in selected cases. They note that comparisons with historical data only indirectly suggest possible mortality reduction. The pooled estimates come from single-arm studies; the authors call for standardized selection criteria and prospective or multicenter studies to better define benefits and risks.
In practice
For teams counseling patients with fetal pleural effusion or congenital lung lesions, these pooled estimates describe outcomes and procedural risks reported after thoracoamniotic shunting, including perinatal death, prematurity, membrane rupture and device complications. Hydrops resolved in a substantial proportion of treated hydropic fetuses, but the review used single-arm data and does not establish that shunting improves survival compared with expectant management or other approaches. The findings support informed discussion of uncertainty, rather than a change in treatment selection; the authors identify standardized selection criteria and prospective studies as needed.
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Ultrasound in Obstetrics & Gynecology: Thoracoamniotic shunting for fetal pleural effusion and congenital lung lesions: systematic review and meta‐analysis ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.