Nonimmune hydrops fetalis: a multidisciplinary approach

In summary, the in utero diagnosis of nonimmune hydrops is associated with a grave prognosis. Antenatal evaluation will determine the cause in many cases, allowing appropriate decisions to be made regarding the management of the pregnancy. To date, no specific in utero therapy exists for most causes of nonimmune hydrops fetalis. At the time of delivery, a resuscitation team will be needed for the infant because extensive resuscitation is likely to be necessary. Many infants will die in the first day of life but some will survive; the survivors will probably require intensive newborn care, including mechanical ventilation. A major cause of mortality in babies with nonimmune hydrops is respiratory insufficiency. If pulmonary hypoplasia is present and severe, survival may not be possible despite intensive care. Review of our data suggests that the diagnosis of idiopathic nonimmune hydrops carries the same grave prognosis as other forms. Currently, only babies with nonimmune hydrops secondary to supraventricular tachycardia have a high probability of survival. Parents of hydropic infants should be counseled concerning the probable outcome and the risk of recurrence. A genetic consultant can help in this regard. Infants who die should have a complete postmortem examination, and placental pathology should be performed in all cases.