520: Can effective intervention reduce mortality in fetal hydrops? - A 15 year review of outcomes

Abstract

To prospectively analyse the etiology, interventions and outcomes in hydrops fetalis (HF) over a 15 year period. To compare the incidence and outcome in fetal hydrops at two time intervals. All cases of HF from 2000 to 2010 were recorded in a high volume European tertiary referral center. Ultrasound findings, neonatal outcomes and autopsy findings were recorded. A second 5 year review was carried out after a 3 year interval (2013-2017) for comparison giving a total of 15 years of data. The incidence overall was 1:1511 (86/130,155). The incidence was significantly lower in the more recent group (2013-2017) with a rate or 1:2105 compared with an incidence of 1:1315 in the earlier group (p=< 0.05). There were 73.1% intrauterine deaths and 26.9% liveborn infants. There were 72% infants that survived to hospital discharge. Etiology was identified in 66% cases, including ; cardiac 29.8%, primary hydrothorax 17.9%, cystic hygromas 13.4%, aneuploidy 9%, fetal anaemia including immune hydrops 4.4% and infection 1.5%. Therapeutic intervention included; Intrauterine transfusions in 4.4%, Thoraco amniotic shunts in 13.4% and medical treatment of cardiac dysrythmia 2.8%. Of those treated 50% survived vs 11% in those that were untreated. Postmortem was performed in 44% of cases that resulted in death, of whom 42% had additional findings identified. Hydrops is rare condition with a high mortality rate of 80.7%. The incidence appears to be decreasing. Two thirds of cases in the study had an identifiable cause, the most common being cardiac pathology. Immune hydrops is now a rare cause of hydrops. One fifth of cases were amenable to treatment of whom half survived. It is important to determine the etiology of hydrops so that treatable causes can be identified. Autopsy provides additional information in 42% of cases.