Share this Article
Ng ZM, Seet MJ, Erng MN, Buendia F, Chang A, Sriram B
Correspondence: Dr Ng Zhi Min, ng.zhi.min@kkh.com.sg
ABSTRACT
INTRODUCTION We aimed to study the profile of nonimmune hydrops fetalis (NIHF) in the local population and identify its outcomes and causes.
METHODS We carried out a retrospective review of the medical records in KK Women’s and Children’s hospital, a single tertiary referral centre, for pregnancies with an antenatal diagnosis of NIHF in the six-year period from 1 January 2005 to 31 December 2010.
RESULTS A total of 29 cases of NIHF were identified; 19 (66%) cases underwent karyotype evaluation, 17 (59%) underwent intrauterine infection screening, and all underwent antenatal thalassaemia screening. The median gestational age at diagnosis was 27 (range 12–37) weeks, median gestational age at birth was 33 (range 27–37) weeks, and median birth weight of live births was 2,480 (range 1,230–3,900) g. The aetiologies for NIHF were identified in 20 (69%) cases, which included cardiac anomalies (n = 5), haematological problems (n = 4), congenital tumours (n = 4), genetic/metabolic disorders (n = 4) and cystic hygromas (n = 3). The cause of NIHF was not identified in the remaining 9 (31%) cases. There were 19 live births – 8 (42%) survived and 11 (58%) died in the neonatal period – and one stillbirth. Nine women opted for medical termination of pregnancy following the diagnosis of NIHF.
CONCLUSION It is important to thoroughly investigate all cases of NIHF and identify its causes in order to provide appropriate antenatal and postnatal counselling. In our series, almost one-third of NIHF cases had no identified aetiology. The neonatal mortality rate was approximately 58%.
Keywords: aetiology, nonimmune hydrops fetalis, outcome
Singapore Med J 2013; 54(9): 487-490; http://dx.doi.org/10.11622/smedj.2013169
REFERENCES
| 1. Bellini C, Hennekam RC, Fulcheri E, et al. Etiology of nonimmune hydrops fetalis: a systematic review. Am J Med Genet A 2009; 149A:844-51. http://dx.doi.org/10.1002/ajmg.a.32655 |
||||
| 2. Santolaya J, Alley D, Jaffe R, Warsof S. Antenatal classification of hydrops fetalis. Obstet Gynecol 1992; 79:256-9. | ||||
| 3. Ratanasiri T, Komwilaisak R, Sittivech A, Kleebkeaw P, Seejorn K. Incidence, causes and pregnancy outcomes of hydrops fetalis at Srinagarind Hospital, 1996-2005: a 10-year review. J Med Assoc Thai 2009; 92:594-9. | ||||
| 4. Yang YH, Teng RJ, Tang JR, et al. Etiology and outcome of hydrops fetalis. J Formos Med Assoc 1998; 97:16-20. | ||||
| 5. Yeo GS, Tan KH, Liu TC. The role of discriminant functions in screening for beta-thalassaemia traits during pregnancy. Singapore Med J 1995; 36:615-8. | ||||
| 6. Yeo GS. Inaugural College of Obstetricians & Gynaecologists Lecture: recent developments in obstetric care and maternal fetal medicine in Singapore. Ann Acad Med Singapore 2004; 33:738-42. | ||||
| 7. Abrams ME, Meredith KS, Kinnard P, Clark RH. Hydrops fetalis: a retrospective review of cases reported to a large national database and identification of risk factors associated with death. Pediatrics 2007; 120:84-9. http://dx.doi.org/10.1542/peds.2006-3680 |
||||
| 8. Stephenson T, Zuccollo J, Mohajer M. Diagnosis and management of non-immune hydrops in the newborn. Arch Dis Child Fetal Neonatal Ed 1994; 70:F151-4. http://dx.doi.org/10.1136/fn.70.2.F151 |
||||
| 9. Trainor B, Tubman R. The emerging pattern of hydrops fetalis--incidence, aetiology and management. Ulster Med J 2006; 75:185-6. | ||||
| 10. Ismail KM, Martin WL, Ghosh S, Whittle MJ, Kilby MD. Etiology and outcome of hydrops fetalis. J Matern Fetal Med 2001; 10:175-81. http://dx.doi.org/10.1080/jmf.10.3.175.181-9 |
||||
| 11. Platt LD, Collea JV, Joseph DM. Transitory fetal ascites: an ultrasound diagnosis. Am J Obstet Gynecol 1978; 132:906-8. | ||||