[Nonimmunologic hydrops fetalis: a review of 30 cases]

Thirty cases of nonimmunologic hydrops fetalis in 14 hospitals were studied. The incidence of nonimmunologic hydrops fetalis was 1 in 4,330 deliveries at all hospitals and 1 in 4,389 deliveries at Tokyo University Hospital. Among these, 13 cases with various kinds of fetal anomalies and 5 cases complicated by twin to twin transfusion syndrome were found. Polyhydramnios (73%), preeclampsia (20%), anemia (34%), and hypoproteinemia (64%) were the commonest prenatal maternal complications, whereas a high incidence of abnormal NST patterns such as loss of variability was found, although urinary E3 levels were within the normal range. High rates of premature labor, Caesarian section and vacuum extraction were found at the deliveries of nonimmunologic hydrops fetalis. Prenatal diagnoses were made in 30% and 85% of the cases before 1977 and between 1978 and 1982, respectively. Ultrasound examination was confirmed to be very useful in detecting the hydropic state in the later period. The perinatal mortality rate from nonimmunologic hydrops fetalis was high (90%); and it was 100% in the cases with anomalies or twin to twin transfusion syndrome. The main cause of neonatal death was respiratory insufficiency due to hypoplasty of the lungs and pleural effusion.