Thoracoamniotic shunting for fetal pleural effusion and congenital lung lesions: systematic review and meta‐analysis

Povzetek

ABSTRACT Objective To summarize reported outcomes associated with thoracoamniotic shunting (TAS) in fetuses with pleural effusion or congenital lung lesions. Methods We conducted a search across MEDLINE, CINAHL, Cochrane CENTRAL, Web of Science, Scopus, and EMBASE databases, from inception to 6 November 2025, for studies reporting the incidence of perinatal outcomes after TAS in pregnancies complicated by fetal pleural effusion or congenital lung lesions. Quality and risk‐of‐bias assessments were performed utilizing the Downs and Black scale. Single‐arm random‐effects meta‐analyses with generalized linear mixed‐effects models were performed to generate pooled proportions with 95% CI. Heterogeneity was assessed using Cochran's Q and quantified by the I 2 statistic. Subgroup analyses were conducted according to the primary diagnosis (pleural effusion or congenital lung lesions). Results Overall, 45 studies, including 1976 fetuses that underwent TAS, were included in the systematic review. Among fetuses with pleural effusion, the pooled proportion of fetal death was 8.3% (95% CI, 5.8–11.6%) ( I 2 = 18.1%) and that of perinatal death was 29.5% (95% CI, 26.4–32.7%) ( I 2 = 27.7%). In cases of congenital lung lesion, the corresponding pooled proportions were 6.6% (95% CI, 3.5–12.1%) ( I 2 = 0%) and 22.6% (95% CI, 13.2–35.9%) ( I 2 = 0%), respectively. Shunt‐related complications included shunt displacement (13.2% (95% CI, 8.8–19.4%) in cases of pleural effusion and 10.2% (95% CI, 4.3–22.3%) in cases of congenital lung lesion) and shunt obstruction or malfunction (14.1% (95% CI, 9.1–21.1%) and 8.6% (95% CI, 2.8–23.4%), respectively). Preterm prelabor rupture of membranes after TAS was reported in 19.3% (95% CI, 13.8–26.4%) of cases of pleural effusion and 15.4% (95% CI, 5.9–34.5%) of cases of congenital lung lesion, and birth < 37 weeks occurred in 64.3% (95% CI, 58.1–70.2%) and 41.6% (95% CI, 29.4–54.8%) of cases, respectively. In hydropic fetuses, resolution of hydrops was achieved in 63.3% (95% CI, 52.9–72.6%) of cases of pleural effusion and 95.1% (95% CI, 82.5–98.8%) of cases of congenital lung lesion. Conclusions TAS in fetuses with pleural effusion or congenital lung lesions is associated with prenatal thoracic decompression and may contribute to resolution of pleural effusion and hydrops in selected cases, with indirect comparisons with historical data suggesting a possible reduction in mortality. Standardized selection criteria and prospective and/or multicenter studies are needed to better define the benefits and risks of TAS. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.