Tiny Lungs, Big Challenges: Navigating Fetal Pleural Effusion Outcomes, Long Term Follow-up and Implications for Future Pregnancies

Fetal pleural effusion is a rare condition involving fluid accumulation in the pleural cavity of the fetus. Invasive procedures are required to exclude chromosomal anomalies and infections, as treatment delays can lead to severe fetal complications. We discuss a case where a 30-year-old primigravida presented at 20 weeks gestation with fetal bilateral pleural effusion and mild ascites. At 23 weeks of gestation, thoracocentesis was performed which revealed chylothorax. The pleural effusion resolved spontaneously by 28 weeks. At 36 weeks, severe oligohydramnios prompted an emergency caesarean section. Postnatal genetic testing found two variants of uncertain significance. The baby improved and was discharged on day six, with no complications over 3.5 years of follow-up. The couple's subsequent pregnancy was uncomplicated. We propose a stepwise management protocol emphasising early diagnosis through ultrasound and cytological analysis, followed by thoracocentesis in severe cases. Regular follow-up is essential to monitor fluid dynamics and adjust management as needed.