title: The severity of immune fetal hydrops is predictive of fetal outcome after intrauterine treatment.
abstract: OBJECTIVE
  This study was undertaken to test the hypothesis that the degree of immune fetal hydrops predicts outcome in red blood cell-alloimmunized pregnancies.
  
  
  METHODS
  In an 11-year period, 213 fetuses received 599 intrauterine transfusions. The outcome of 208 pregnancies, including two pairs of twins, was analyzed in a retrospective study. Eighty fetuses demonstrated ultrasonographic signs of hydrops at the start of treatment; 42 of these were classified as mildly hydropic and 38 were classified as severely hydropic. Reversal of hydrops as a result of treatment, survival, and neonatal morbidity was studied.
  
  
  RESULTS
  The overall survival rate of fetuses with hydrops was 78%. Of the fetuses with mild hydrops, 98% survived, whereas in cases of severe hydrops the survival rate was 55%. Intrauterine reversal of hydrops occurred in 65% of the fetuses with hydrops. The reversal rate was 88% in fetuses with mild hydrops and 39% in fetuses classified as severely hydropic. After reversal of hydrops, almost all of the fetuses survived (98%), whereas in cases of persistent hydrops outcome was unfavorable, with a survival rate of 39% for all fetuses and 26% for fetuses classified as severely hydropic.
  
  
  CONCLUSIONS
  In contrast with severe hydrops, there is a high rate of reversal of mild hydrops after adequate treatment. In our study 98% of fetuses survived after reversal of hydrops. To improve the outcome of red blood cell-alloimmunized pregnancies, early diagnosis of fetal anemia and referral to a specialized center are important; these steps enable the start of intrauterine treatment when hydrops is absent or still mild.
authors.affiliation: Department of Obstetrics, Fetal Medicine Unit, Leiden University Medical Center, The Netherlands.
authors.forename: I L
authors.initials: IL
authors.lastname: van Kamp
authors.forename: F J
authors.initials: FJ
authors.lastname: Klumper
authors.forename: R S
authors.initials: RS
authors.lastname: Bakkum
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
authors.forename: R H
authors.initials: RH
authors.lastname: Meerman
authors.forename: S A
authors.initials: SA
authors.lastname: Scherjon
authors.forename: H H
authors.initials: HH
authors.lastname: Kanhai
mesh_terms: D001805:Blood Transfusion, Intrauterine; D004899:Erythroblastosis, Fetal / Q000628:therapy*; D005260:Female; D005544:Forecasting; D006801:Humans; D015160:Hydrops Fetalis / Q000276:immunology / Q000503:physiopathology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012203:Rh Isoimmunization / Q000628:therapy*; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome