Prognostic factors and prenatal management in non immune hydrops fetalis are still a dilemma

Seventeen cases of non-immune hydrops fetalis (NIHF) were diagnosed prenatally at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia over a period of 15 years (1979-1994). In nine patients (53%) a possible underlying mechanism was suspected. Of the six patients who survived beyond the first year of life, four had normal neurological and development follow-up. Family history was positive for NIHF in five cases (29%): two of these had a history of four siblings each who had been diagnosed with NIHF. All patients had prenatal ascites and subcutaneous oedema diagnosed by ultrasound. All five patients who had prenatal ascites, pericardial and pleural effusion died, while 9 of 11 (82%) patients who had prenatal pleural effusion and ascites also succumbed. Four of five (80%) patients with congenital anomalies died. One patient required intrauterine blood transfusion because of fetal anemia with subsequent partial resolution of the hydrops. Two patients received digitalis transplacentally for treatment of congestive heart failure secondary to congenital heart disease without response. We conclude that the presence of prenatal pericardial and pleural effusion or congenital anomalies carries a very poor prognosis in patients with NIHF.