Management of non-immune hydrops: 8 years' experience.
During a period of 8 years (1985-92), 100 fetuses were diagnosed to have non-immune hydrops on the basis of ultrasonographic findings and absence of rhesus isoimmunization. Both the mother and the fetus were thoroughly evaluated by a set protocol that included a detailed fetal abnormality scan with echocardiography and fetal blood sampling. A cause for non-immune hydrops could be identified in 81% of the fetuses. Cardiovascular abnormalities (23%) and alpha(1)-thalassemia (22%) were almost equally common etiological factors in the South-East Asian population under investigation. A chromosomal abnormality was detected in 10% of the fetuses with non-immune hydrops. Twenty-six fetuses were found to be suitable for in utero therapy. In utero therapy included one or more of the following: (1) fetal intravascular blood transfusion; (2) direct fetal drug therapy; and (3) fetal pleuroamniotic shunting. Eighteen of the 26 babies (69.2%) were alive and well at 1 month after delivery. It is concluded that in well-selected cases appropriate in utero fetal therapy can lead to significant improvement in fetal salvage.
Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, Singapore.
C
C
Anandakumar
A
A
Biswas
Y C
YC
Wong
D
D
Chia
V
V
Annapoorna
S
S
Arulkumaran
S
S
Ratnam
D005069:Evaluation Studies as Topic; D005260:Female; D005312:Fetal Blood / Q000276:immunology; D005313:Fetal Death; D005315:Fetal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D015160:Hydrops Fetalis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000379:methods*; D011379:Prognosis; D016216:Ultrasonography, Prenatal