PROGNOSTIC FACTORS AND PRENATAL MANAGEMENT IN NON IMMUNE HYDROPS-FETALIS ARE STILL A DILEMMA

Seventeen cases of non-immune hydrops fetalis (NIHF) were diagnosed pr enatally at King Faisal Specialist Hospital and Research Centre, Riyad h, Saudi Arabia over a period of 15 years (1979-1994). In nine patient s (53%) a possible underlying mechanism was suspected. Of the six pati ents who survived beyond the first year of life, four had normal neuro logical and development follow-up. Family history was positive for NIH F in five eases (29%): two of these had a history of four siblings eac h who had been diagnosed with NIHF. All patients had prenatal ascites and subcutaneous oedema diagnosed by ultrasound. All five patients who had prenatal ascites, pericardial and pleural effusion died, while 9 of 11 (82%) patients who had prenatal pleural effusion and ascites als o succumbed. Four of five (80%) patients with congenital anomalies die d. One patient required intrauterine blood transfusion because of feta l anemia with subsequent partial resolution of the hydrops. Two patien ts received digitalis transplacentally for treatment of congestive hea rt failure secondary to congenital heart disease without response. We conclude that the presence of prenatal pericardial and pleural effusio n or congenital anomalies carries a very poor prognosis in patients wi th NIHF.