Investigation of nonimmune hydrops fetalis: Multidisciplinary studies are necessary for diagnosis - Review of 94 cases

This review of 94 cases of nonimmune hydrops fetalis (NIHF) over a 10-year period was undertaken to evaluate the frequency of this pathology among fet al and infant deaths and to determine the most common likely etiologies in a northeastern region of France. NIHF represented 6% of the fetal deaths ex amined in our laboratory. The combination of findings from morphologic exam ination of the placenta and fetus with the results of microbiological and c ytogenetic investigations (conventional cytogenetic study, fluorescent in s itu hybridization [FISH], or DNA ploidy image analysis) led to an etiologic diagnosis for NIHF in two-thirds of the cases and suggested a diagnosis in an additional 23% of cases. The most common causes of NIHF were chromosome abnormalities (33%), infections (16%), and cardiac pathology (13.8%). The detection of a cause for NIHF is important for genetic counseling and manag ement of subsequent pregnancies. Our experience suggests that a diagnosis i s possible in a large majority of NIHF when obstetricians and pathologists carefully coordinate the management of prenatal and postnatal investigation s and when new techniques, such as molecular biology and DIVA quantificatio n, are used.