title: The many faces of hydrops.
abstract: OBJECTIVE
  Fetal hydrops arises from multiple disease processes and can portend a grim prognosis. We reviewed our experience with hydropic fetuses to understand relevant antenatal anatomic and physiologic predictors of survival.
  
  
  METHODS
  We reviewed fetal ultrasounds and echocardiograms of hydropic fetuses evaluated from 1996 to 2013.
  
  
  RESULTS
  Overall neonatal survival in 167 fetuses was 44% (range, 0-75%) and was influenced by the underlying disease process. The anatomic distribution of fluid varied and was not significantly different between survivors and nonsurvivors. Univariate analysis indicated that resolution of hydrops and delivery at a later gestational age were predictive of survival (OR: 5.7 (95% CI: 2.5-13.2) and OR: 1.3 (95% CI: 1.1-1.4), respectively). Fetal intervention also improved survival in some diseases. Echocardiograms were reviewed to group fetuses with similar cardiac physiology and defined categories with high or low/normal cardiothoracic ratio (CTR). Among patients with a high CTR, the cardiovascular profile score was predictive of survival (p=0.009).
  
  
  CONCLUSIONS
  Survival in hydrops depends on the underlying disease, available fetal therapies to resolve hydrops, and the gestational age of delivery and not on the specific anatomic manifestations of hydrops. In hydropic fetuses with high CTRs, the cardiovascular profile score may be a useful prognostic indicator.
authors.affiliation: Fetal Treatment Center, The University of California, San Francisco, CA, United States; Department of Surgery, The University of California, San Francisco, CA, United States.
authors.forename: S Christopher
authors.initials: SC
authors.lastname: Derderian
authors.affiliation: Fetal Treatment Center, The University of California, San Francisco, CA, United States; Department of Surgery, The University of California, San Francisco, CA, United States.
authors.forename: Cerine
authors.initials: C
authors.lastname: Jeanty
authors.affiliation: Department of Pediatrics, The University of California, San Francisco, CA, United States.
authors.forename: Shannon R
authors.initials: SR
authors.lastname: Fleck
authors.affiliation: Fetal Treatment Center, The University of California, San Francisco, CA, United States; Department of Surgery, The University of California, San Francisco, CA, United States.
authors.forename: Lily S
authors.initials: LS
authors.lastname: Cheng
authors.affiliation: Fetal Treatment Center, The University of California, San Francisco, CA, United States; Department of Pediatrics, The University of California, San Francisco, CA, United States.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Peyvandi
authors.affiliation: Fetal Treatment Center, The University of California, San Francisco, CA, United States; Department of Pediatrics, The University of California, San Francisco, CA, United States.
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Moon-Grady
authors.affiliation: Fetal Treatment Center, The University of California, San Francisco, CA, United States.
authors.forename: Jody
authors.initials: J
authors.lastname: Farrell
authors.affiliation: Fetal Treatment Center, The University of California, San Francisco, CA, United States; Department of Surgery, The University of California, San Francisco, CA, United States.
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Hirose
authors.affiliation: Fetal Treatment Center, The University of California, San Francisco, CA, United States; Department of Obstetrics and Gynecology, The University of California, San Francisco, CA, United States.
authors.forename: Juan
authors.initials: J
authors.lastname: Gonzalez
authors.affiliation: Fetal Treatment Center, The University of California, San Francisco, CA, United States; Department of Pediatrics, The University of California, San Francisco, CA, United States.
authors.forename: Roberta L
authors.initials: RL
authors.lastname: Keller
authors.affiliation: Fetal Treatment Center, The University of California, San Francisco, CA, United States; Department of Surgery, The University of California, San Francisco, CA, United States. Electronic address: Tippi.Mackenzie@ucsfmedctr.org.
authors.forename: Tippi C
authors.initials: TC
authors.lastname: MacKenzie
mesh_terms: D005260:Female; D046128:Fetal Therapies; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal
keywords: Cardiovascular profile score; Fetal echocardiography; Fetal ultrasonography; Hydrops; Hydrops fetalis