Antenatal evaluation and management in nonimmune hydrops fetalis

Thirty-eight cases of nonimmune hydrops fetalis were evaluated by detailed real-time ultrasonography and two-dimensional echocardiography. Before ultrasound evaluation, all mothers had a complete blood count, titers for toxoplasmosis, rubella, cytomegalovirus, and herpes (TORCH screen), serum albumin, and a Kleihauer-Betke stain of a peripheral blood smear. Karyotyping of fetal fibroblasts or lymphocytes was performed if these examinations were not diagnostic. A probable etiology was found in 27 (71%) cases. These were chromosome abnormality (nine), pulmonary (three), viral (three), hematologic (two), transient ascites (two), renal (one), skeletal (two), and gastrointestinal (one). Despite extensive antenatal and postmortem examinations, no etiology was found in 11 (28.9%) cases. Although early diagnosis was accomplished in many cases allowing for the option of antenatal therapy, the survival rate was 23.7%, similar to previous reports.