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The changing pattern of fetal hydrops
D C Wilson1, H L Halliday, G McClure
1Neonatal intensive care unit, Royal Maternity Hospital.
Insights
Fetal hydrops, a major cause of newborn death, is increasingly non-immune in origin. Advances in care have reduced its mortality rate significantly, offering improved outcomes for affected infants.
Area of Science:
- Perinatology
- Neonatology
- Obstetrics
Background:
- Fetal hydrops (hydrops fetalis) is a critical condition associated with high fetal and neonatal mortality.
- Decreased incidence of rhesus iso-immunisation due to anti-D prophylaxis, enhanced antenatal screening, and improved neonatal intensive care have positively impacted clinical outcomes.
- A shift towards non-immune causes of fetal hydrops has been observed.
Purpose of the Study:
- To review the incidence and causes of fetal hydrops.
- To evaluate changes in the etiology of fetal hydrops over time.
- To assess trends in mortality rates for fetal hydrops.
Main Methods:
- Retrospective review of 27 liveborn cases of hydrops fetalis.
- Data collected from the Royal Maternity Hospital, Belfast, between 1974 and 1989.
- Analysis of case origins, focusing on immune versus non-immune etiologies.
Main Results:
- In the latter five years of the study period (1985-1989), 40% of fetal hydrops cases were non-immune in origin.
- The overall mortality rate for fetal hydrops decreased from 100% in the earlier period to 50% in the later period.
- The study period spanned 16 years, providing a temporal perspective on the condition.
Conclusions:
- Fetal hydrops is increasingly attributed to non-immune causes.
- Advances in medical interventions have led to a substantial reduction in fetal hydrops mortality.
- Continued monitoring and research are essential for managing fetal hydrops effectively.
Abstract:
Fetal hydrops (hydrops fetalis) remains a significant cause of fetal and neonatal mortality. The decreased incidence of rhesus iso-immunisation due to prophylaxis with rhesus immune globulin (anti-D), improved antenatal ultrasound screening, and advances in neonatal intensive care have greatly altered the clinical outlook in this condition. A retrospective review of all 27 liveborn cases of hydrops in the Royal Maternity Hospital, Belfast in the period 1974-89 showed that in the last five years 40% of cases were non-immune in origin. The mortality rate fell from 100% in the first part of the study to 50% in the second.