{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:00:41Z","timestamp":1786118441522,"version":"build-2736575974"},"reference-count":47,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective(s)<\/jats:title>\n                    <jats:p>Fetal pleural effusion is a rare condition that may significantly impact fetal and neonatal outcomes. Currently, no universal standardized approach exists for diagnosing and managing primary fetal pleural effusions. This study aimed to develop structured, expert\u2010based clinical guidelines for the diagnosis, monitoring, management, and follow\u2010up care of primary fetal pleural effusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A Delphi method was employed to achieve consensus among an international panel of experts in fetal medicine. Experts were selected based on their clinical expertise, affiliations, and relevant publications. A three\u2010round anonymous electronic survey was sent to the full panel. In the initial two rounds, participants rated each statement on a Likert scale (1\u20135) and provided suggestions for modifications. Statements with a median score of five and no suggested changes were accepted as consensus. Statements with a median score below four were rejected. Statements scoring a median of four were revised according to suggestions and reconsidered in the subsequent round. In the final round, participants indicated their agreement or disagreement with the remaining statements. Consensus was defined as agreement from more than 70% of participants with no suggestions for further changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 101 expert clinicians accepted the invitation and completed the first round with 73 (72%) completing all three rounds. Consensus statements were achieved on aspects of diagnosis, monitoring, intervention, post\u2010intervention management, and delivery. Key recommendations concerning the diagnosis of primary fetal pleural effusion include the use of ultrasound as the primary modality for identifying fetal pleural effusion and excluding secondary causes through detailed genetic, infectious, and metabolic evaluations. Management strategies emphasized thoracoamniotic shunting as the preferred intervention in hydropic fetuses with primary pleural effusion. Experts reached consensus that shunt placement could be offered as early as 16\u00a0weeks. No consensus was reached for isolated effusion without hydrops, as management was considered case\u2010dependent. The importance of ultrasonographic monitoring of fetal status at least weekly post\u2010intervention was strongly endorsed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion(s)<\/jats:title>\n                    <jats:p>The Delphi method facilitated the development of a consensus\u2010based protocol for diagnosing and managing primary fetal pleural effusion. These standardized guidelines are intended to enhance clinical practice across various settings, improve perinatal outcomes, and serve as a foundation for future research for this high\u2010risk fetal condition.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pd.70221","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T08:06:04Z","timestamp":1784016364000},"page":"1312-1322","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["International Expert Consensus on the Diagnosis and Clinical Management of Primary Fetal Pleural Effusion"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2257-7519","authenticated-orcid":false,"given":"May","family":"Abiad","sequence":"first","affiliation":[{"name":"Fetal Care &amp; Surgery Center, Division of Fetal Medicine and Surgery Boston Children's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Javinani","sequence":"additional","affiliation":[{"name":"Fetal Care &amp; Surgery Center, Division of Fetal Medicine and Surgery Boston Children's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria C.","family":"Lopez","sequence":"additional","affiliation":[{"name":"Departamento de Ciencias Cl\u00ednicas Universidad Icesi  Cali Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew H.","family":"Mossayebi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Brigham and Women's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Van Mieghem","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Fetal Medicine Unit Mount Sinai Hospital and University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Fetal Medicine Unit University Hospitals  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3642-5858","authenticated-orcid":false,"given":"Rodrigo","family":"Ruano","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, UHealth Jackson Fetal Care Center, Department Obstetrics Gynecology and Reproductive Sciences University of Miami Miller School of Medicine  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6145-2532","authenticated-orcid":false,"given":"Edward","family":"Araujo J\u00fanior","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Paulista School of Medicine\u2014Federal University of S\u00e3o Paulo (EPM\u2010UNIFESP)  S\u00e3o\u00a0Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1068-8932","authenticated-orcid":false,"given":"Ingrid","family":"Schwach","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Paulista School of Medicine\u2014Federal University of S\u00e3o Paulo (EPM\u2010UNIFESP)  S\u00e3o\u00a0Paulo Brazil"},{"name":"Department of Obstetrics and Gynecology Medical Science College of Santa Casa of S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology Columbia University Irving Medical Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Yinon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Sheba Medical Center  Tel\u2010Hashomer Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Cincotta","sequence":"additional","affiliation":[{"name":"Mater Centre for Maternal Fetal Medicine Mater Mothers' Hospital  South Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9301-0790","authenticated-orcid":false,"given":"Erin E.","family":"Perrone","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Pediatric Surgery University of Michigan Michigan Medicine C.S. Mott Children's Hospital  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9387-1849","authenticated-orcid":false,"given":"Haruhiko","family":"Sago","sequence":"additional","affiliation":[{"name":"Center for Maternal\u2010Fetal and Neonatal Medicine National Center for Child Health and Development  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique C.","family":"Haak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology, Division of Fetal Medicine Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar Bennasar","family":"Sans","sequence":"additional","affiliation":[{"name":"BCNatal Maternal Fetal Medicine Center Hospital Cl\u00ednic i Hospital Sant Joan de D\u00e9u University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerardo Sepulveda","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Instituto de Salud Fetal Hospital Regional Maternoinfantil de Monterrey Tecnologico de Monterrey Escuela de Medicina y Ciencias de la Salud  Monterrey M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-7670","authenticated-orcid":false,"given":"Asma","family":"Khalil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George's Hospital St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5686-667X","authenticated-orcid":false,"given":"Cesar","family":"Meller","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Fetal Medicine Unit Hospital Italiano de Buenos Aires Instituto Universitario Hospital Italiano  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramen 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