Immune and non-immune hydrops fetalis in a resource-limited setting: a report of two cases

Hydrops fetalis is a fetal condition characterized by abnormal fluid accumulation in multiple fetal compartments and is associated with high perinatal mortality. Unlike high-income settings, both immune and non-immune hydrops fetalis (IHF and NIHF) remain relevant in low- and middle-income countries (LMICs), where evaluation and specialized care are often delayed or inaccessible. We report two cases of hydrops fetalis diagnosed antenatally at a tertiary referral hospital in Kenya, followed through delivery and outcome. Case one involved immune hydrops fetalis due to suspected non-Rhesus alloimmunization, presenting with fetal ascites and cardiac dysfunction. Management included paracentesis and intrauterine transfusions, which temporarily stabilized the fetus, but the neonate died on day two of life. Case two involved non-immune hydrops fetalis initially presenting with isolated pleural effusion, which progressed to generalized hydrops. Amniotic fluid testing showed Rubella IgM positivity. Management included thoracocentesis and conservative management till 34+0 weeks´ gestation. Unfortunately, the pregnancy resulted in an intrauterine fetal demise. These cases illustrate the wide spectrum of hydrops fetalis and the diagnostic and therapeutic challenges in resource-limited settings. While antenatal interventions may prolong gestation, outcomes are largely determined by the underlying cause and disease severity.