OP23.09: Perinatal outcome in fetuses with dislodged pleuroamniotic shunts (PAS)
Bibliographic record
Abstract
To evaluate perinatal outcome in fetuses with large primary pleural effusions treated with PAS, which subsequently dislodged in utero. 169 fetuses underwent PAS at a single tertiary fetal medicine centre from 1991-2016. Fetuses whose shunts subsequently dislodged were identified and categorised as intra- or extra-thoracic dislodgment. Gestational age (GA) at insertion and dislodgement, presence of hydrops, procedural factors, need for re-shunting, neonatal outcomes and long-term follow-up for respiratory or other complications were reviewed. In 169 fetuses with PAS, inserted at 18.6-36.7 wks GA, 15 shunts (8.9%) subsequently became dislodged. 9/15 (60%) fetuses had bilateral pleural effusions and 10/15 (67%) were hydropic. Fetal rotation was required in 7/15 fetuses to facilitate the original shunt insertion. Six shunts (4%) dislodged into the amniotic cavity. In 9 fetuses, 5 with bilateral and 4 with unilateral PAS, one of the shunts dislodged intra-thoracically (5%). Of these, 6 (67%) were hydropic, which resolved in 4 after shunting. Only 1 intra-thoracic shunt was removed neonatally, as the external tip was easily located in the chest wall. Three fetuses, 2 with intra- and one with extra-thoracic dislodgment, required re-shunting antenatally. There was only one death - an iatrogenic complication during neonatal shunt insertion. On long-term follow-up of 8 infants (ages 1-19 yrs) [one neonate excluded, as birth was <1 wk before abstract deadline], with intra-thoracic shunt dislodgement, none have required surgical removal and none have had any respiratory sequelae or other complications related to the retained shunt. 9% of fetal PAS subsequently became dislodged antenatally. In 8 of 9 neonates whose PAS dislodged internally, the shunts remain intrathoracic at an average of 10.5 yrs of age (0.9-19.6 yrs), without any related respiratory or other complications. Internally displaced shunts appear to be well tolerated and do not require surgical removal.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".