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• W2012605332 abstract "Chylothorax complicating pregnancy is rare, as all cases were reported to be associated with labor or lymphangioleiomyomatosis (LAM) 1. We report the first known case of a pregnant woman at 27th gestational week with spontaneous chylothorax. She was treated with periodic drainage of chylous effusion for more than 7 weeks until she delivered a healthy baby. A 26-year-old Chinese woman, gravida 1, para 0, at 27th week of gestation, developed acute serious dyspnea without any predisposing factors. Both chest X-ray and computerized tomographic scan revealed a massive left pleural effusion but no typical multiple cysts. Opalescent fluid was drawn out from the pleural cavity through thoracentesis and was confirmed to be chylous fluid by chemical examinations. All of these findings supported the diagnosis of spontaneous chylothorax. Conservative treatment consisted of continuous closed drainage by thoracostomy and parenteral nutrition. The quantity of drainage increased from 2000 ml every 4 days at the beginning to 2000 ml per day at the 34th gestational week. Moreover, maternal blood electrolytes were evaluated every 2 days, which were normal until hypokalemia (K+, 3.2 mmol/l) was observed at the 34th week and 3rd gestational day. Fetal growth was found to be normal by ultrasound examination and fetal heart rate monitor. After supplementation of potassium chloride, a low transverse cesarean section was performed under epidural anesthesia on the next day, and a male infant weighing 2450 g, with Apgar scores of 9 and 10 at 1 and 5 min, respectively, was labored out. The placenta appeared normal. The color and volume of the amniotic fluid were normal. About 500 ml per day of chylous effusion was drawn out from the pleural cavity through continuous closed drainage after the operation. Prophylactic antibiotics (metronidazole 1.83 g and cefatrizine 4 g per day) were administered intravenously for 3 days. The patient was transferred from the Department of Maternal-Fetal Medicine to the Department of Chest Surgery to undergo thoracotomy on postpartum day 7. Lymphangiography did not show any abnormalities in the lungs, pleurae, or mediastinum but showed a rupture of small lymphatic channels at the mediastinum. Thoracotomy to ligate the lymphatic vessel at the esophageal hiatus was performed under chest X-ray and lymphangiography on postpartum day 20. The biopsy of the mediastinum showed no evidence of LAM. Chylous effusion ceased after the operation. And, the patient was discharged on the 14th day after the operation. Chylothorax has not recrudesced for more than 8 months. Most cases of chylothorax during pregnancy are associated with labor, for intrathoracic and intra-abdominal pressure change during labor, especially in the second stage of labor 2, 3. Others cases were due to complications of pulmonary LAM 1, 4. The isolated chylothorax in our case, which occurred in the second trimester and with no evidence of LAM, is not in accordance with former reports. Hence, it is assumed that the cause is idiopathic. Conservative therapy, that is continuous drainage of chylous effusion, is rarely used in pregnant women with chylothorax because of vast protein loss and its ineffectiveness 1. Although the patient in our study experienced a slowly progressive chylothorax and hypokalemia, we, however, believed that conservative therapy for 7 weeks will be useful in a pregnant woman in her second trimester by prolonging gestational age and making the fetus mature when fetus statue and complications of chylothorax are assessed under close monitoring. It is believed that acute chest surgery would confer a higher risk to fetus than conservative therapy." @default.
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• W2012605332 date "2006-01-01" @default.
• W2012605332 modified "2023-09-27" @default.
• W2012605332 title "Pregnancy complicated by spontaneous chylothorax – a case report" @default.
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• W2012605332 doi "https://doi.org/10.1080/00016340600609012" @default.
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