Vesicoamniotic and thoracoamniotic shunting

What is vesicoamniotic and thoracoamniotic shunting?

Some fetal abnormalities can cause a build-up of fluid that can be fatal if left untreated. By placing a small tube called a shunt while the baby is still in the womb, we can drain the fluid and lessen the strain on the baby’s body.

Vesicoamniotic shunting is used to treat urinary tract obstructions. It allows the baby’s urine to drain directly into the amniotic space. Thoracoamniotic shunting is used to treat pleural effusion, congenital pulmonary airway malformations (CPAMs) and other conditions that can compress a baby’s heart, lungs or kidneys.

The mother is given either local or regional anesthesia for this procedure. Under ultrasound guidance, the maternal fetal medicine specialist inserts a needle through the mother’s abdomen and into the part of the baby’s body that is filled with excess fluid. The shunt is passed through the needle and placed into position, with the end sticking out of the baby’s body so the fluid can drain into the amniotic space. If necessary, the surgeon may add fluids to the amniotic sac at the same time. The mother and baby receive antibiotics to prevent infection. The procedure may need to be repeated if the shunt is displaced because of the baby’s movement or other reasons.

Candidates for vesicoamniotic and thoracoamniotic shunting

If your baby’s ultrasound shows a fetal abnormality that is leading to a life-threatening build-up of fluid, your doctor may recommend vesicoamniotic or thoracoamniotic shunting. 

• For safety’s sake, patients must meet the following criteria:
• The baby’s condition must be severe enough to warrant fetal intervention.
• The baby must not have a genetic problem or any other major birth defect.
• The mother must be pregnant with only one baby.

While vesicoamniotic and thoracoamniotic shunting are generally considered safe and beneficial, in rare cases this procedure can lead to serious complications. It’s also possible that the shunt can be displaced as the baby grows. The specialists at the Fetal Concerns Center will help you decide whether shunting is the right option for you and your baby.

How does vesicoamniotic and thoracoamniotic shunting affect my baby?

Draining the excess fluid can reduce the size of an abnormal mass or obstruction, reverse hydrops and significantly improve a baby’s survival rate.

How does vesicoamniotic and thoracoamniotic shunting affect the pregnancy?

Your pregnancy will be closely monitored to make sure the shunt stays in place and that no further complications develop. Preterm labor or premature rupture of membranes is a possibility. You may still be able to deliver vaginally unless there is a medical reason for a C-section. If your baby’s condition worsens, you may need to deliver early at the Froedtert & the Medical College of Wisconsin Birth Center.

What about after the vesicoamniotic and thoracoamniotic shunting?

You should be able to go home that same day, but you may need to return for follow-up monitoring every 1-2 weeks until delivery. If your baby requires additional support after birth, he or she will receive top-notch care in Children’s Wisconsin’s Level IV Neonatal Intensive Care Unit, which is ranked as one of the best in the nation.

Will I be able to help care for my baby?

Absolutely. Our recently expanded and redesigned NICU was created to promote family bonding, with private rooms where parents can stay with their baby 24/7, and other special features for families’ comfort. Our on-call lactation specialists can help you successfully breastfeed and pump and store breast milk when direct breastfeeding isn’t an option.

When can my baby go home?

Your baby will be discharged from the hospital once he or she is breathing independently, eating well and gaining weight. That may take several weeks. Premature babies will likely require a longer NICU stay.

What’s my baby’s long-term prognosis?

That depends on the nature and severity of your baby’s condition. Babies who have not yet developed hydrops generally have better outcomes. Fetal interventions are still relatively new procedures performed at very few centers, and researchers continue to collect data on how long-term outcomes compared with babies who don’t receive treatment until after birth. Research shows that vesicoamniotic and thoracoamniotic shunting can increase survival in otherwise life-threatening situations.

What about future pregnancies?

A history of fetal vesicoamniotic and thoracoamniotic shunting should not affect future pregnancies.