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Fetuses with chlothorax complicated by symptomatic polyhhydramnios or hydrops far from term require in-utero therapy.Conventionally, fetal pleuroamniotic shunting is the preferred option.Fetal pleurodesis with OK-432 is an emerging treatment modality.We reported the first case of successful fetal pleurodesis with OK-432 for recurrent severe fetal primary chylothorax after failing repeated pleuroamniotic shunting.Shunting and pleurodesis could be complementary to each other in the treatment of fetal chylothorax.