Current evidence on the safety and efficacy of pleuro–amniotic shunts to drain fetal pleural effusions appears adequate. However, there are uncertainties about the natural history of fetal pleural effusion and about patient selection. Therefore, this procedure should not be used without special arrangements for consent and for audit or research.
Clinicians wishing to undertake insertion of pleuro–amniotic shunt for fetal pleural effusion should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that parents understand the uncertainties around the natural history of the condition and case selection, and provide them with clear written information. Use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients who undergo insertion of pleuro–amniotic shunt for fetal pleural effusion (see NICE's interventional procedures outcomes audit tool).
This procedure should only be performed in centres that specialise in invasive fetal medicine and in the context of a multidisciplinary team, which should include a consultant in fetal medicine, a neonatologist and a specialist midwife.
Further evidence on case selection will be useful. NICE may review the procedure upon publication of further evidence.