No. 363-Investigation and Management of Non-immune Fetal Hydrops

Utility of chromosomal microarray for diagnosis in cases of nonimmune hydrops fetalis

“…The American College of Obstetricians and Gynecologists as well as the Society for Maternal‐Fetal Medicine (SMFM) recommend chromosomal microarray (CMA) as the genetic test of choice for fetuses with structural anomalies when invasive testing is pursued, and both SMFM and the Society of Obstetricians and Gynaecologists of Canada recommend a karyotype and/or CMA when diagnostic testing is pursued for NIHF specifically . However, the utility of CMA for NIHF remains poorly understood.…”

“…The American College of Obstetricians and Gynecologists as well as the Society for Maternal-Fetal Medicine (SMFM) 5 recommend chromosomal microarray (CMA) as the genetic test of choice for fetuses with structural anomalies when invasive testing is pursued, and both SMFM and the Society of Obstetricians and Gynaecologists of Canada recommend a karyotype and/or CMA when diagnostic testing is pursued for NIHF specifically. 1,6 However, the utility of CMA for NIHF remains poorly understood. A secondary analysis of a large prospective study 7 suggested an incremental yield of 6% in clinically relevant cytogenetic information when CMA was compared to karyotype among cases with at least one abnormal fetal fluid collection, although this was not designed as the primary outcome of the study.…”

Fetal hydrops – a review and a clinical approach to identifying the cause

“…The blood capillary wall has a basic level of leakiness (permeability) to fluids and small solutes, which increases in inflammatory states. Fetal anaemia (in addition to uteroplacental insufficiency) leads to anoxic damage to cells and decreased capillary wall integrity [9]. With increased capillary permeability, proteins leak into the interstitium causing an increase of the interstitial colloid osmotic pressure, which in turn leads to increased fluid loss from the blood capillaries into the interstitium and resultant oedema.…”

“…In virtually all cases of hydrops related to a cardiac abnormality the heart is enlarged and the degree of enlargement has been shown to correlated with the central venous pressure [73]. Those babies with a congenital cardiac malformation who develop fetal hydrops have an extremely poor prognosis with a mortality rate of 92% [9]. A proportion of those babies with structural cardiac malformations will be identified as having causative chromosomal abnormalities or single gene disorders.…”

Évaluation fœtale prénatale : 75 ans plus tard (1945-2019)

“…Des donn ees probantes indiquent que l' echographie au premier trimestre avec datation de l'âge gestationnel, un examen pr ecoce de l'anatomie foetale, le d epistage de l'aneuploïdie ou anomalie foetale biochimique avec clart e nucale et l' evaluation de la pr e eclampsie maternelle est li ee a une am elioration des soins 12,13 . Les anomalies cibl ees d etect ees par echographie font l'objet de lignes directrices pour l' etude et la prise en charge de l'anasarque foetoplacentaire 26 , de la microc ephalie 27 et des anomalies du tube neural 28 .…”