Prenatal diagnosis and management of nonimmune hydrops fetalis

We examined the incidence, aetiological factors and outcome in 40 cases of nonimmune hydrops fetalis (NIH) and suggest a rational approach to manageme nt. The incidence of NIH was 1 in 830 deliveries during the last 10-year pe riod. In spite of extensive antenatal and postnatal investigation no cause could be established in 14 (35%,) cases. A probable aetiological factor was found in 65% of cases. These included viral infection (7), cardiovascular (6), twin-to-twin transfusion (3), chromosomal abnormality (3), other malfo rmation syndromes (4), renal dysplasia (1), laryngeal atresia (1) and sever e fetomaternal haemorrhage (1). Five of the 40 fetuses survived, 2 treated antenatally for tachyarrhythmia, 2 had spontaneous resolution and the fifth fetus had repeated intrauterine transfusions because of human parvovirus B 19-induced anaemia. After diagnosis of nonimmune hydrops fetalis, early ref erral to a tertiary centre is to be encouraged for investigation and provis ion of intensive perinatal care. Investigation allows parents to be counsel led appropriately that the mortality is no longer 100% and a steadily growi ng number may be amenable to some form of fetal therapy.