Hydrops fetalis – has there been a change in diagnostic spectrum and mortality?

Abstract

Objective. To investigate the impact of medical progress on the diagnostic spectrum and outcome of infants with hydrops fetalis (HF).

Study design. We reviewed the charts of all live-born HF infants (n = 70) over a 16-year period (1993–2009). Data were compared to two published case series (Wafelman LS, Pollock BH, Kreutzer J, Richards DS, Hutchison AA. Biol Neonate 1999;75:73–81, Gainesville, Florida 1983–1992, n = 62; Simpson JH, McDevitt H, Young D, Cameron AD. Fetal Diagn Ther 2006;21:380–382, Glasgow, UK 1990–2004, n = 30).

Results. Only two cases were immune HF. The proportion of infants with unexplained HF (30%), lymphatic (24%), cardiac (17%), hematologcial (6%) or chromosomal anomalies (6%) did not differ from the published case series. There was also no difference in overall mortality (57% vs. 55% or 67%, respectively). Low gestational age (<34 weeks), low 5-min Apgar scores (<4), and heart failure were independently associated with fatality.

Conclusion. The diagnostic spectrum and mortality of HF has changed little over the last 25 years. In the future, new techniques in mutational analysis will be needed to reduce the high rate of unexplained cases of HF.

Keywords:

• Medical progress
• non-immune hydrops fetalis
• live-born infants' outcome
• unexplained cases

Acknowledgements

The authors are very grateful to Sarah Smithson-Compton, MA for editorial assistance. No specific financial support was provided to any of the authors for their participation in this article.