Non-immune hydrops fetalis--prognostic factors based on fetal echo (analysis in 230 cases)

Objective: The aim of the research was to assess whether all reasons of NIHF were leading to the same poor outcome.

Methods: The material of the research study consisted of 192 fetuses with follow up from 230 fetuses with NIHF who had echocardiography and detailed sonography between 1992 and 2002.

Results: The most common anomalies associated with NIHF were cardiological anomalies n = 71 (30.8). The remain extracardiac causes of NIHF were: so called "other structural defects" n = 24 (10.4%), infections (without myocarditis) n = 24 (10.4%), multiple structural defects n = 20 (8.7%), urogenital defects n = 17 (7.4%), pulmonary anomalies n = 17 (7.4%), gastrointestinal anomalies n = 12 (5.2%), chromosomal defects n = 8 (3.5%), mirror syndrome n = 2 (0.9%) and idiopathic n = 35 (15.3%). In the group of NIHF 102 fetuses (44.3%) presented echocardiographic signs of congestive heart failure which statistically increased mortality ratio. In the group of fetuses with NIHF follow up was established in 192 (83.4%) fetuses/newborns; there were n = 139 (72.4%) demise and n = 53 (27.6%) alive. Therapy in utero was applied to 28 cases. In this group 13 fetuses/newborns (46.4%) survived.

Conclusions: Multiple structural anomalies and cardiological anomalies causing NIHF are connected with poor prognosis for fetus or neonate. Congestive heart failure coexisting with NIHF (in our series in about 44%) significantly increased mortality ratio what point the special role of fetal echocardiography. Relatively better prognosis was observed possible in cases with NIHF without structural anomalies and mild intensify or due to infection but without cardiac anomalies. In selected fetuses therapy in utero may increase the survival ratio.