Clinical Course and Outcome of Non-Immune Fetal Hydrops in Singleton Pregnancies.

Theresa Reischer,Cécile Monod,Christian Göbl,Tina Linder,Anja Catic,Bernadette Muth,Gülen Yerlikaya-Schatten

doi:10.3390/jcm11030702

Theresa Reischer, Cécile Monod + Show 5 more

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https://doi.org/10.3390/jcm11030702

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Abstract

Nonimmune fetal hydrops is a condition defined by abnormal fluid accumulation in two or more body compartments. The aim is to evaluate factors associated with adverse outcome in diagnosed fetal hydrops and to investigate the aspects for the decision making in the case of termination of pregnancy. Therefore, a retrospective data analysis of pregnancies complicated by non-immune hydrops fetalis between 2004 and 2018 was performed in a single tertiary referral center. Of 361 pregnancies with diagnosed fetal hydrops, in 183 cases (50.7%), the parents decided to terminate the pregnancy. A strong relationship between etiology and termination of pregnancy was demonstrated, whereas the highest rates of termination of pregnancy were found if a chromosomal aberration was diagnosed. Of the remaining 178 cases, 51 cases (28.7%) had a miscarriage, 33 cases (18.5%) had an intrauterine fetal death, and 94 cases (52.8%) were live born, whereas 26 (27.7%) of these offspring died within the first week of life. The risk of an adverse outcome increased with lower gestational age at diagnosis (p < 0.001). A nuchal translucency thickness greater than 2.5 mm was associated with an adverse outcome (p < 0.01). Furthermore, pregnancies with adverse outcome had significantly more affected compartments (median: 3; IQR 2), compared with live born cases (median: 2; IQR 1; p < 0.01). In conclusion, adverse outcome in pregnancies with fetal hydrops was associated with a lower gestational age at diagnosis, nuchal translucency greater than 2.5 mm and a higher count of affected compartments. These results confirm that a precise clinical workup to identify the underlying etiology of non-immune fetal hydrops is essential for a better prognostic assessment and accurate counselling of parents.

Highlights

The aim of the study was to investigate the clinical course and pregnancy outcome of all fetuses diagnosed with non-immune hydrops fetalis (NIHF) (i) to investigate pregnancy outcome for fetuses with increased nuchal translucency (NT) ≥ 2.5mm and hydrops in particular, (ii) to determine factors associated with the decision on termination of pregnancy if fetal hydrops was diagnosed, and (iii) to investigate factors associated with an adverse outcome in fetuses with hydrops if parents decided to continue the pregnancy
Statistical analyses were performed using IBM SPSS Static Version 23. In this single tertiary prenatal center with an average of 2600 live births per year, we evaluated 361 pregnancies complicated by excessive fluid accumulation over a period of 15 years
With a multivariate logistic regression model, we evaluated the association between several factors associated with adverse outcome in the 178 cases where the parents decided to continue the pregnancy

Summary

Introduction

1. Introduction with regard to jurisdictional claims in Hydrops fetalis is a condition characterized by abnormal fluid accumulation within two or more compartments and body cavities of the fetus [1]. Introduction with regard to jurisdictional claims in Hydrops fetalis is a condition characterized by abnormal fluid accumulation within two or more compartments and body cavities of the fetus [1] It is classified as either immune hydrops fetalis, due to rhesus alloimmunization, or non-immune hydrops fetalis (NIHF), whereas NIHF is the cause in more than 85% of fetuses [2,3]. 25% of cases [6,7], a growing number of conditions have been identified as the cause for hydrops fetalis

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