Objectives To review all cases with fetal pleural effusions referred to the Centre for Fetal Care at Queen Charlotte's and Chelsea Hospital (QCCH) and document the antenatal management and ascertain the neonatal outcome.

Methods All cases referred to the CFC at QCCH with pleural effusions for the period 2001–2006 were assed according to departmental protocol including history of consanguinity, other abnormalities, fetal echocardiography and TORCH screening. All cases were identified from the fetal medicine database (Astraia) and neonatal notes.

Results 94 cases with fetal pleural effusions were identified, isolated pleural effusion was present in 24 (25.5%) fetuses, 8 (33.3%) were unilateral and 16 (66.6%) were bilateral. Secondary causes of pleural effusions were diagnosed in 70 (74.4%) fetuses, 20 (28.5%) cardiac, 5 (7.1%) neural tube defect, skeletal 8 (11.4%), 9 (12.8%) gastrointestinal, 2 (2.8%) cleft lip, 3 (4.2%) pulmonary, 4 (5.7%) renal, 5 (7.1%) twin to twin transfusion syndrome, 2 (2.8%) vascular, 7 (10%) chromosomal and 4 (5.7%) viral infection.

Karyotyping was offered to all cases, results were normal in 41 (78.8%), aneuploidy in 7 (13.4%) and viral infection in 4 (7.7%) cases. 10 (10.6%) cases underwent termination of pregnancy, 16 (17%) intrauterine death and 68 (72.3%) live births. Intrapartum thoracocentesis and pleuroamniotic shunt was done in all 24 (23.5%) cases of primary pleural effusions, 13 (54%) resolved, 9 (37.5%) reaccumulated, 1 (4%) preterm premature rupture of membranes.

Conclusions Although thoracocentesis is the initial management step, it is unlikely to be of benefit. The limited experience with pleuroamniotic shunts suggest that they are effective in decompressing the effusion and improving survival.