Perinatal Outcomes of Pleuro-Amniotic Shunting in Isolated Pleural Effusions: Systematic Review and Meta-analysis

Abstract

Pleuro-amniotic shunting has been proposed for fetal pleural effusion, although its safety and efficacy remain uncertain. Therefore, we aimed to evaluate the perinatal outcomes of the fetal therapy for isolated pleural effusion through a systematic review and single-arm meta-analysis. PubMed/MEDLINE, Embase, Scopus, and Cochrane Central were searched for studies reporting outcomes of fetuses undergoing pleuro-amniotic shunting for isolated pleural effusion. The primary outcomes were overall survival and resolution of fetal hydrops. Single-arm random-effects meta-analyses were performed to estimate pooled event rates with 95% confidence intervals (CI). Ten retrospective cohort studies comprising 416 fetuses treated with pleuro-amniotic shunting were included. The pooled overall survival rate was 65.36% (95% CI 59.46–70.83; I 2 = 30.7%). Resolution of fetal hydrops occurred in 62.25% of cases (95% CI 54.27–69.62; I 2 = 0%). A total of 62 catheter displacements were recorded, corresponding to a combined prevalence of 17.13% (95% CI 13.59–21.36). Overall, there were 155 preterm births, resulting in a pooled prevalence of 69.67% (95% CI 61.24–76.95; I 2 = 26.9%). Preterm premature rupture of membranes (PPROM) prevalence was 17.65% (95% CI 7.78–35.28; I 2 = 84.5%; p < 0.001). Pleuro-amniotic shunting achieves overall survival in approximately two-thirds of treated fetuses and resolving fetal hydrops in most cases. However, the procedure may be associated with preterm birth and PROM, underscoring the need for multidisciplinary perinatal management. Although the evidence is limited, these findings support pleuro-amniotic shunting as a promising treatment for progressive isolated fetal pleural effusion and highlight the need for prospective studies to optimize patient selection and perinatal care.