Detection of hydrops fetalis during an ultrasound examination triggers in o
ur minds several questions. Is this a hydrops or something else? How signif
icant for the pregnancy is this finding? What is the cause? What is the pro
gnosis for this and future pregnancies? What to tell the parents? How to co
unsel them incorporating all of the previous information to help them make
the best possible decision? This article presents the available evidence to
help to answer those questions. Hydrops fetalis is usually separated into
immune and nonimmune hydrops (NIH) based on the presence or absence of feta
l anemia secondary to red cell alloimmunization, respectively. This article
is mostly concerned with the latter because the management of immune hydro
ps fetalis, with few exceptions, follows the guidelines for red cell alloim
munization without hydrops.