OUTCOME OF NONIMMUNE HYDROPS-FETALIS DIAGNOSED DURING THE FIRST-HALF OF PREGNANCY

Objective: To evaluate the etiology and outcome of fetal hydrops of no nimmune origin diagnosed in utero during the first half of pregnancy. Methods: We reviewed 45 cases of nonimmune fetal hydrops presenting be tween 11 and 17 weeks' gestation over a 4-year period. Results: The me dian gestational age at diagnosis of fetal hydrops was 14 weeks. Place ntal edema was most commonly associated with generalized skin edema. A scites was also observed in four cases, but no case presented with ple ural or pericardial effusion. The fetal karyotype was abnormal in 35 c ases (77.8%). Of the ten fetuses with a normal karyotype, four were cl assified as idiopathic, three had isolated atrioventricular septal def ect, two were associated with maternal infection, and one had multiple pterygium. Fetal heart rate anomalies were found in both chromosomall y normal and abnormal fetuses. All but one of the karyotypically abnor mal pregnancies and five of ten euploid pregnancies were terminated. I n all six pregnancies that continued, resolution occurred before mid-g estation. Three continuing euploid pregnancies resulted in fetal death , and only two had a normal outcome. Conclusion: Nonimmune fetal hydro ps diagnosed before 18 weeks' gestation is associated with a higher in cidence of aneuploidy than hydrops diagnosed during the second half of pregnancy. In most affected fetuses with a normal karyotype, spontane ous resolution occurred before 24 weeks' gestation, although the outco me was generally unfavorable. (C) 1997 by The American College of Obst etricians and Gynecologists.