Citations 2
International Expert Consensus on the Diagnosis and Clinical Management of Primary Fetal Pleural Effusion
Abiad, May , Javinani, Ali, Lopez, Maria C., Mossayebi, Matthew H., Mieghem, Tim Van, Russo, Francesca, Ruano, Rodrigo , Britto, I.S. , Miller, Russell, Yinon, Yoav, Cincotta, Robert, Perrone, Erin E. , Sago, Haruhiko , Haak, Monique C., Sans, Mar Bennasar, Gonzalez, Gerardo Sepulveda, Chmait, Ramen H., Habli, Mounira, Sun, Raphael C., Chaveeva, Petya, Espinoza, Jimmy, Schenone, Mauro , Sun, Lu‐Ming, Nassr, Ahmed A., Moon‐Grady, Anita, Shamshirsaz, Alireza A., Krispin, Eyal, Araujo Júnior, Edward , Britto, Ingrid Schwach Werneck , Perrone, Erin E , Sago, Haruhiko , Khalil, Asma , Meller, Cesar , Mustafa, Hiba J , Schenone, Mauro H , Papanna, Ramesha , Ruano, Rodrigo , Abiad, May , Javinani, Ali , Mossayebi, Matthew H. , Van Mieghem, Tim , Russo, Francesca Maria , Miller, Russell , Yinon, Yoav , Cincotta, Robert , Haak, Monique C. , Sans, Maria del Mar Bennasar, Gonzalez, G. Sepulveda, Chmait, Ramen H. , Habli, Mounira A. , Chaveeva, Petya , Espinoza, Jimmy , Nassr, Ahmed A. , Moon‐Grady, Anita J. , Shamshirsaz, Alireza A. , Krispin, Eyal
Prenatal Diagnosis | July 14, 2026 | Volume: 46 | Issue: 9 | Pages: 1312-1322
ABSTRACT Objective(s) Fetal pleural effusion is a rare condition that may significantly impact fetal and neonatal outcomes. Currently, no universal standardized approach exists for diagnosing and managing primary fetal pleural effusions. This study aimed to develop structured, expert‐based clinical guidelines for the diagnosis, monitoring, management, and follow‐up care of primary fetal pleural effusion. Methods A Delphi method was employed to achieve consensus among an international panel of experts in fetal medicine. Experts were selected based on their clinical expertise, affiliations, and relevant publications. A three‐round anonymous electronic survey was sent to the full panel. In the initial two rounds, participants rated each statement on a Likert scale (1–5) and provided suggestions for modifications. Statements with a median score of five and no suggested changes were accepted as consensus. Statements with a median score below four were rejected. Statements scoring a median of four were revised according to suggestions and reconsidered in the subsequent round. In the final round, participants indicated their agreement or disagreement with the remaining statements. Consensus was defined as agreement from more than 70% of participants with no suggestions for further changes. Results A total of 101 expert clinicians accepted the invitation and completed the first round with 73 (72%) completing all three rounds. Consensus statements were achieved on aspects of diagnosis, monitoring, intervention, post‐intervention management, and delivery. Key recommendations concerning the diagnosis of primary fetal pleural effusion include the use of ultrasound as the primary modality for identifying fetal pleural effusion and excluding secondary causes through detailed genetic, infectious, and metabolic evaluations. Management strategies emphasized thoracoamniotic shunting as the preferred intervention in hydropic fetuses with primary pleural effusion. Experts reached consensus that shunt placement could be offered as early as 16 weeks. No consensus was reached for isolated effusion without hydrops, as management was considered case‐dependent. The importance of ultrasonographic monitoring of fetal status at least weekly post‐intervention was strongly endorsed. Conclusion(s) The Delphi method facilitated the development of a consensus‐based protocol for diagnosing and managing primary fetal pleural effusion. These standardized guidelines are intended to enhance clinical practice across various settings, improve perinatal outcomes, and serve as a foundation for future research for this high‐risk fetal condition.
Prenatal assessment of congenital diaphragmatic hernia at north american fetal therapy network centers: A continued plea for standardization
Perrone, Erin E. , Abbasi, Nimrah , Umar, Uzma, Johnson, Anthony , Ladino-Torres, Maria, Ruano, Rodrigo , (NAFTNet), North American Fetal Therapy Network, Papanna, Ramesha , Cortes, Magda Sanz , Ruano, Rodrigo , Perrone, Erin E , Ryan, Greg , (NAFTNet), North American Fetal Therapy Network, Papanna, Ramesha
Prenatal Diagnosis | October 30, 2020 | Volume: 41 | Issue: 2 | Pages: 200-206
AbstractIntroductionPrenatal work‐up for congenital diaphragmatic hernia (CDH) is important for risk stratification, standardization, counseling, and optimal therapeutic choice. To determine current practice patterns regarding prenatal CDH work‐up, including prenatal ultrasound and magnetic resonance imaging (MRI) use, and to identify areas for standardization of such evaluation between fetal centers.MethodsA survey regarding prenatal CDH work‐up was sent to each member center of the North American Fetal Therapy Network (NAFTNet) (n = 36).ResultsAll responded. Sonographic measurement of lung‐to‐head ratio (LHR) was determined by all, 89% (32/36) of which routinely calculate observed‐to‐expected LHR. The method for measuring LHR varied: 58% (21/36) used a “trace” method, 25% (9/36) used “longest axis,” and 17% (6/36) used an “antero‐posterior” method. Fetal MRI was routinely used in 78% (28/36) of centers, but there was significant variability in fetal lung volume measurement. Whereas all generated a total fetal lung volume, the planes, methodology and references values varied significantly. All evaluated liver position, 71% (20/28) evaluated stomach position and 54% (15/28) quantified the degree of liver herniation. More consistency in workup was seen between centers offering fetal intervention.ConclusionPrenatal CDH work‐up and management differs considerably among North American fetal diagnostic centers, highlighting a need for its standardization.