Pleural Effusion/Kalethorax - sorry its long!

I've previously posted about our 19 week scan giving us a thicker nuchal fold measurement which led to a higher risk of Down Syndrome and extra monitoring.

Because of this extra monitoring, I went in for a scan at 28 weeks and 4 days. I knew something was off and when I went in to see the Doctor she hit me with the fact that bubs had fluid on the lungs and an almost absent return blood flow through the cord into the placenta, and so I was going to be admitted that day and would deliver the next. She told me to go home, get my bag and come back where they would discuss everything in more detail and start me on steroids. On the way back to the hospital, I got a call from my Doc who had called her collegue at the Women's and Children's hospital, in the Maternal Fetal Medicine unit there. The lead obstrecian wanted to see me that day to look at other options.

So off we went, where we met the new doctor, who is amazing (IMO!). He took a look and basically said it wasn't looking good, but he didn't want to deliver. Bub had a left pleural effusion, meaning fluid in the lung cavity on the left side, and a secondary pleural effusion on the right (which the Doc wasn't as concerned about). The fluid on the left was so great that it had pushed her diaphram down and her heart out of position. This was putting pressure on the arteries at the top of the heart, which was why there was absent blood flow in the cord - she was struggling to pump the blood back out.

The doctor drained 80mls of fluid from the left lung (same needle as an amnio), which was painful, and the relief in her body was apparent pretty much immediately. He admitted me that night, as the procedure could cause me to go into labour, and also he wanted bub monitored.

The next day, he arrived bright and early (on a Saturday) to take me for another scan and unfortunately the fluid had reaccumulated much quicker than he would have liked. He advised us that he would like to put a stent into the baby's lung cavity - a chest drain basically, which would continuosly drain the fluid from the cavity into the amniotic sac. This was an even bigger needle than the day before, so the procedure had to be done in theatre, and I was prepped just in case they needed to do a c-section there and then. They gave the bub a muscle relaxant to keep her still and me a local anaesthetic, but ouch, did it hurt. We were moved to the high dependency unit on the labour ward, so I could be continuosly monitored until my contractions died down (which they did after a couple of doses of whatever it is they give you to stop labour) and to ensure baby woke up ok from the muscle relaxant, which took to the next morning.

I was in hospital until the following Thursday, whilst baby stabilised and we could ensure the stent was working. By the Monday, the fluid had reduced to barely a sliver and her cord dopplers were normalising, and by the Thursday, the dopplers were back to normal, which surprised even the doctor at how normal they were.

We're now 5 weeks further on from being told we would deliver the next day and I'm happy to say, bub is still baking away. I'm currently having weekly scans to check bub, and so far, all is looking ok. The doctor is happy that as long as things stay this way, I can get to term and have a natural (albeit heavily monitored) birth.

It turns out the pleural effusions have something to do with a kalethorax, which is something to do with the lymphatitic system and so at birth, there will be a team from NICU, ready to take bub. We spoke with a neonatoligst consultant (who was fantastic) yesterday, and we could be in for anything from 24hours in NICU, to a few days, a few weeks or worst case, a few months, depending on how quickly the fluid stops accumalting, and whether the problem clears up on its own, or we need some help.

And now its just a wait and see how long she's happy for and what happens post birth.

Wow! That is a huge procedure. Isn't it amazing what things can be done in-utero these days. I hope your baby girl continues to bake until term. Then I hope you have a great birth and a smooth ride from there on in. Being told you would deliver at 28 weeks must have been so very scary for you. Now at 33 weeks along you have come so far. Wishing all the best!

I am familiar with a PE, but have never heard of a kalethorax... something to research! It sounds like you and your daughter are receiving excellent medical care. I wish you the very best for the next few weeks and I hope that your gorgeous girl has a smooth ride after her entry to the world. :hug:

What a journey you have had. Sounds like you have a little fighter in there! hoping that the next few weeks are much more boring.

:hug:

For those googling, try chylothorax :-) it really is amazing what they can do now.

Amazing! Happy baking bubba. Fx for a great delivery and positive outcome.

Wow! Such an eventful time. Praying for you and your little one. Keep us posted!

Oh wow what a journey! Fingers crossed for more good news and success!

Amazed at the technology these days! I remember your posts about the nt scans and glad you have an awesome specialist looking after bubs ;)
Looking forward to hearing your birth announcement!!

Wow, what a stressful time. Sounds like you have a wonderful team on board. Keep baking little girl!

Far out! I am amazed at the things Drs can do for babies inutero these days. Sounds like you are in great hands. My Bridesmaid had her baby at 31w at the WCH and her boy was in the NICU for well over a month, the care he received was simply amazing and he is now a perfectly healthy 3yo. Wishing you an normal birth and I hope that bubs stay in the NICU will be a short one

Absolutely amazing what they can do now!! sounds like you're in great hands. Best wishes for the coming weeks and months. Will be good to hear your BA :D

I'm so glad to hear you've had a good outcome from all the interventions you and your tiny baby have been through so far. I believe the term in 'chylothorax' if you want to look it up. (Chyle is another name for lymphatic fluid.)