Background and Objectives: Fetal pleural effusions are either primary or secondary to chromosomal or structural fetal abnormalities. In both cases, thoraco-amniotic shunts may be indicated to prevent life-threatening consequences. In this report, we describe a rare complication of shunts and successful in utero management of this complication. We also summarize the prior reports of shunt wrapping around fetal limbs and successful prenatal release of the shunts. Data Source: Search including PubMed, MEDLINE and EMBASE databases from inception till November 2015 was conducted for cases with shunt entrapment around fetal limbs with or without prenatal management. Results: Four cases including our case have been reported in the literature with wrapping of shunts around fetal limbs. Three of these cases were successfully managed prenatally using different interventional and anesthetic techniques. Conclusions: Prenatal shunts could be rarely complicated by wrapping of the shunt around fetal limbs with possible serious vascular and neurological consequences. Different techniques have been described for prenatal management of this condition. We describe a less invasive approach that could be done under local anesthesia in suitable cases.

Keywords:
Thoraco-amniotic shunt, Fetoscopy, Prenatal therapy
1.
Yinon Y, Kelly E, Ryan G: Fetal pleural effusions. Best Pract Res Clin Obstet Gynaecol 2008;22:77-96.
2.
Mallmann MR, Graham V, Rösing B, Gottschalk I, Müller A, Gembruch U, Geipel A, Berg C: Thoracoamniotic shunting for fetal hydrothorax: predictors of intrauterine course and postnatal outcome. Fetal Diagn Ther 2016, DOI: 10.1159/000446110.
3.
Adams TM, Kunzier NB, Chavez MR, Vintzileos AM: Ultrasound-guided retrieval and position replacement of a dislodged fetal pleuro-amniotic shunt: a novel approach for a known complication of feto-amniotic shunting. Fetal Diagn Ther 2015;39:78-80.
4.
Merchant AM, Peranteau W, Wilson RD, Johnson MP, Bebbington MW, Hedrick HL, Flake AW, Adzick NS: Postnatal chest wall deformities after fetal thoracoamniotic shunting for congenital cystic adenomatoid malformation. Fetal Diagn Ther 2007;22:435-439.
5.
Belfort MA, Shamshirsaz AA, Whitehead WE, Ball R, Silver R, Ruano R, Espinoza J, Mann DG, McCullough L, Chervenak F: Unusual pleuro‐amniotic shunt complication managed using a 2‐port in‐CO2 fetoscopic technique: technical and ethical considerations. Ultrasound Obstet Gynecol 2016;47:123-124.
6.
Brown R, Nicolaides K: Constriction band of the arm following insertion of a pleuro‐amniotic shunt. Ultrasound Obstet Gynecol 2000;15:439-440.
7.
Chan FY, Borzi P, Cincotta R, Burke J, Tudehope D: Limb constriction as a complication of intra-uterine vesico-amniotic shunt: fetoscopic release. Fetal Diagn Ther 2002;17:315-320.
8.
Kurtz M, Koh CJ, Jamail GA, Sangi-Haghpeykar H, Shamshirsaz AA, Espinoza J, Cass DL, Olutoye OO, Olutoye OA, Braun MC, Roth DR, Belfort MA, Ruano R: Factors associated with fetal shunt dislodgement in lower urinary tract obstruction. Prenat Diagn 2016;36:720-725.
© 2016 S. Karger AG, Basel
2016
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