[Intrauterine treatment of nonimmunologic hydrops fetalis associated with pleural effusion].

Four fetuses with nonimmunologic hydrops fetalis were treated in utero. The initial diagnosis was made between 27 and 32 weeks of gestation. All fetuses had generalized edema and pleural effusion at the time of diagnosis. In order to maintain plasma colloid osmotic pressure in the fetus, fetal transfusion of albumin was carried out. Because pleural effusion may inhibit fetal lung development, serial in utero thoracocentesis guided by ultrasonic tomography was carried out. In three of four fetuses, cord blood albumin concentration were within normal range. Urine volume in fetuses significantly increased after fetal transfusion of albumin. These results suggested that this procedure was useful in maintaining plasma colloid osmotic pressure in the fetus. Although pleural effusion was removed completely by in utero thoracocentesis, pleural effusion appeared within 1 hour after the procedure and rapidly increased thereafter until the 24th hour. There were no fatal trauma from the procedure. In all infants, generalized edema, ascites and pleural effusion were presented at birth, and Apgar scores at one minute were less than 7. All died of pulmonary insufficiency within 16 hours after delivery. At autopsy, their lungs were smaller than those of the other infants.