Non-immune hydrops fetalis: A practical guide for obstetricians

Delima Khairudin, Zarko Alfirevic, Fionnuala Mone, Kate Navaratnam*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

Introduction
Hydrops Fetalis is the accumulation of two or more fetal fluid collections, including pericardial effusion, pleural effusions, ascites and skin oedema. In the absence of red-cell alloimmunisation, hydrops fetalis is non-immune and affects approximately 1:2000 pregnancies. Non-immune hydrops fetalis (NIFH) is associated with severe perinatal morbidity/mortality and some significant maternal risks including maternal mirror syndrome. Priorities for clinicians are determining the cause antenatally to optimise management and discuss treatment options, if available. Systematic reviews have indicated that a cause can be identified prenatally in ~60% cases. Recent evidence indicates fetal exome sequencing can provide a diagnosis in 30% of previously unexplained cases. This article provides a practical, evidence-based guide to evaluation and management of affected pregnancies.

Key content
Ultrasound evaluation and investigations, including analysis of ascitic fluid and fetal exome sequencing (es)
Fetal and maternal surveillance and management; mirror syndrome, timing and mode of delivery
Outcomes and guide to counselling parents

Learning objectives
Understand causes of NIFH and perinatal and maternal morbidity/mortality
Appreciate basis for investigations, including ES Understand how care can be effectively shared by referring units and tertiary fetal medicine units

What this review adds
We provide a practical guide to investigation and management of NIFH, including evidence on the value of fetal exome sequencing and statistics for counselling parents.
Original languageEnglish
Pages (from-to)110-120
JournalThe Obstetrician and Gynaecologist
Volume25
Issue number2
DOIs
Publication statusPublished - 01 Apr 2023

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