Survival in non-immune hydrops fetalis without malformation or chromosomal abnormalities after invasive treatment.
The aim of the study was to determine the outcome of fetuses with non-immune hydrops (NIH) following modern invasive investigation and therapy. This prospectively planned observational study involved 23 women with singleton fetuses in whom a diagnosis of NIH was made in our fetal medicine unit in 1 year. After investigation and counselling 15 of the 23 women opted for termination of pregnancy (10 chromosomal and 5 structural abnormalities) and there was 1 intrauterine fetal death before therapy was attempted. One case with diaphragmatic hernia was treated with shunting which successfully reversed the hydrops, the pregnancy continued to term, the malformation was surgically corrected but the neonate died from pulmonary hypoplasia. In the remaining 6 cases structural and chromosomal abnormalities were excluded. One had amniotic fluid drainage for polyhydramnios but despite this delivered at 30 weeks' gestation and the neonate died on day 5. The remaining 5 cases had fetal therapy between 22 and 32 weeks' gestation (4 shunt insertions, 1 blood transfusion) and in all the hydrops reversed and the pregnancy continued to at least 35 weeks' gestation. All 5 neonates were discharged from hospital alive and well. Fetal therapy in cases of NIH with normal structure and karyotype was associated with a very good outcome. Giving a uniform poor prognosis is no longer justified because if other fetal abnormalities are excluded, in utero treatment, reversal of the hydrops and survival are often possible. We recommend urgent referral of these cases to a fetal medicine unit.
Ayida
G A
GA
Queen Charlotte's and Chelsea Hospital, London, UK.
Soothill
P W
PW
Rodeck
C H
CH
D000293:Adolescent; D000328:Adult; D002452:Cell Count; D002869:Chromosome Aberrations / Q000401:mortality*; D025063:Chromosome Disorders; D005260:Female; D005313:Fetal Death; D005315:Fetal Diseases / Q000401:mortality* / Q000628:therapy; D005328:Fetal Viability; D005333:Fetus / Q000002:abnormalities*; D006801:Humans; D015160:Hydrops Fetalis / Q000401:mortality* / Q000628:therapy; D007621:Karyotyping; D008214:Lymphocytes / Q000166:cytology; D010996:Pleural Effusion / Q000166:cytology; D011247:Pregnancy; D011379:Prognosis; D016896:Treatment Outcome