Isolated fetal ascites

Abstract

To determine the natural history of apparently isolated ascites diagnosed by antenatal ultrasonography we reviewed our recent experience. This was a retrospective review of 14 patients (1994–2001) with an antenatal diagnosis of isolated ascites (14–29 weeks), made at a tertiary assessment centre and classified subjectively at presentation as either severe (three cases), moderate (five cases) or mild (four cases). The outcomes for the three fetuses with severe ascites at presentation were one termination of pregnancy (19 weeks), one fetal demise (15 weeks) and one liveborn infant (36 weeks). The final diagnosis in the fetus undergoing TOP was laryngeal atresia, whereas postmortem examination in the fetus delivered at 15 weeks revealed no other anomalies. The liveborn baby required surgery for a large pseudocyst with distal bowel opening into the cyst and proximal bowel adherent to the posterior cyst surface. This baby is progressing well following a primary bowel anastamosis. All five pregnancies complicated by moderate ascites at initial presentation resulted in liveborn infants; three appear normal, one is awaiting genetic assessment for mild facial dysmorphism and one required a prolonged admission to the neonatal nursery following delivery at 31 weeks. This baby became hydropic and developed a right renal vein thrombosis. All four babies with mild ascites are making good progress, but one required surgery for an ileal atresia.