Non‐Immune Hydrops Fetalis: Do Placentomegaly and Polyhydramnios Matter?

Berger, Victoria; Sparks, Teresa N.; Jelin, Angie C.; Derderian, Chris; Jeanty, Cerine; Gosnell, Kristen; MacKenzie, Tippi C.; González, Juan M.

doi:10.1002/jum.14462

Cited by 13 publications

(18 citation statements)

References 22 publications

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“…In our study, a considerable proportion of fetuses with pleural effusion had polyhydramnios, and therefore, it could be argued that they have a higher risk of preterm delivery and neonatal death. This has been previously reported by Berger et al [14] who showed a higher prevalence of preterm delivery <34 weeks of gestation among hydropic fetuses with polyhydramnios (60% 60/100) as compared to hydropic fetuses without polyhydramnios (28.6% 6/21, p = 0.01). Whether polyhydramnios is associated with a short cervix has been studied by several authors with controversial results.…”

Section: Discussionsupporting

confidence: 86%

Preoperative Cervical Length Predicts the Risk of Delivery within One Week after Pleuroamniotic Shunt in Fetuses with Severe Hydrothorax

Gámez-Varela¹,

Martínez‐Rodríguez²,

López‐Briones³

et al. 2021

Fetal Diagn Ther

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Objective: The objective of this study was to assess the predictive performance of preoperative cervical length (CL) for delivery within 1 week after pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax. Methods: A prospective cohort of fetuses with severe hydrothorax referred to our fetal surgery center in Querétaro, Mexico from January 2012 to July 2020. Severe fetal hydrothorax was diagnosed as an accumulation of fluid within the fetal pleural space accompanied with severe bilateral lung compression, mediastinal shift, polyhydramnios, and/or hydrops. Transvaginal CL was measured immediately before PAS, and a short cervix was defined as that <25 mm. The interval from fetal intervention to delivery, prevalence of preterm prelabor rupture of membranes (PPROMs), and associations with delivery within the first week after PAS according to a short or a normal CL, were evaluated. Results: Thirty-five pregnancies with severe fetal hydrothorax treated with PAS were evaluated. Median gestational age at PAS was (weeks + days) 31+2 (range, 26+0–36+1). Two (5.7%) and 7 (20.0%) cases delivered within the first 24 h and 1 week after PAS, respectively. Ten (28.6%) women had a short cervix before PAS, while 25 (71.4%) had normal preoperative CL. Women with a short cervix showed lower mean interval between fetal intervention and delivery (2.4 vs. 5.5 weeks, p = 0.01), and higher prevalence of PPROM (50 vs. 12%, p = 0.01), as compared to women with a nonshort cervix. Preoperative short cervix was associated with significantly higher risk of delivery within the first 24 h (20.0 vs. 0%, respectively, p < 0.05) and 1 week after PAS (50.0 vs. 8.0%, respectively, p < 0.01) compared with pregnancies with normal preoperative CL. Conclusion: In pregnancies with severe fetal hydrothorax candidates for pleuroamniotic shunt, identification of a short cervix before fetal intervention can predict delivery within 1 week after the surgical procedure.

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Section: Discussionsupporting

confidence: 86%

Preoperative Cervical Length Predicts the Risk of Delivery within One Week after Pleuroamniotic Shunt in Fetuses with Severe Hydrothorax

Gámez-Varela¹,

Martínez‐Rodríguez²,

López‐Briones³

et al. 2021

Fetal Diagn Ther

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“…The overall risk of PTB in our study (86%) was higher than previously reported (66-76%). 4,5,13,14 Because many of the previously published studies on outcomes of hydropic pregnancies included smaller cohorts of patients who delivered many years ago, it is possible that changing protocols for antenatal management with serial ultrasounds and nonstress testing are partially responsible for an increase in PTB, particularly given our finding that most PTBs were iatrogenic for fetal indications. Advances in neonatal care and an increasing expertise in the care of premature newborns may also have contributed to the greater frequency of PTB in our cohort.…”

Section: Discussionmentioning

confidence: 99%

“…One factor underlying spontaneous PTB may be polyhydramnios, which is known to complicate NIHF pregnancies and may predispose to PTB. 4,7,8 Preeclampsia is also associated with NIHF pregnancies and its development often necessitates medically indicated delivery. 9 Additional risk factors for PTB may include underlying fetal genetic disorders, fetal distress, and earlier diagnosis of fetal fluid collections.…”

mentioning

confidence: 99%

“…Nonimmune hydrops fetalis (NIHF) is a rare complication of pregnancy, but one that is associated with high risks of preterm birth (PTB), fetal genetic disorders, poor neonatal outcomes, and maternal morbidity. [1][2][3][4] Given the neonatal risks inherent to PTB and lack of clear evidence to support improved outcomes for hydropic neonates delivered preterm, early delivery is generally not recommended in the absence of fetal or maternal clinical deterioration. 2 However, approximately two-thirds of pregnancies complicated by NIHF result in PTB.…”

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confidence: 99%

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Understanding Preterm Birth in Pregnancies Complicated by Nonimmune Hydrops Fetalis

et al. 2023

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Objective: Nonimmune hydrops fetalis (NIHF) is associated with poor perinatal outcomes including preterm birth (PTB). However, the frequency and causes of PTB in this population are not well understood. We hypothesized that NIHF frequently results in PTB due to medically indicated delivery for fetal distress. Study Design: This was a secondary analysis of a prospectively enrolled cohort of pregnancies with NIHF that underwent exome sequencing if standard testing was non-diagnostic. The primary outcome was frequency of PTB at <37 weeks’ gestation. Secondary outcomes were reasons for PTB, fetal predictors of PTB, and frequency of neonatal death following PTB. Results: Fifty-six cases were included, with a median gestational age at delivery of 32.8 weeks (IQR 30.3-35.0). Overall, 86% (48/56) were delivered preterm. Among 48 PTBs, 18 (38%) were spontaneous, 9 (19%) were medically indicated for maternal indications (primarily preeclampsia), and 21 (44%) were medically indicated for fetal indications (non-reassuring antenatal testing or worsening effusions). Neither fetal genetic diagnosis nor polyhydramnios were associated with PTB. Conclusion: More than four fifths of pregnancies with NIHF result in PTB, often due to non-reassuring fetal status. These data are informative for counseling patients and for developing strategies to reduce PTB in pregnancies with NIHF.

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“…Generally, NIHF presents a poor prognosis that varies from preterm birth to intrauterine fetal demise (IUFD), stillbirth, neonatal morbidity, and mortality [1,[9][10][11]. The prognosis of NIHF depends on the etiology and gestational age at the time of diagnosis and delivery [12].…”

Section: Introductionmentioning

confidence: 99%

Genetic Disorders and Pregnancy Outcomes of non-immune Hydrops Fetalis in a Tertiary Referral Center

Guo

Lin

et al. 2022

Preprint

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Background: Non-immune hydrops fetalis (NIHF) is a nonspecific symptom with a wide variety of disorders, and the prognosis depends on the underlying etiology. The aim of the study was to investigate the incidence of chromosomal abnormalities and α0/α0 thalassemia in non-immune hydrops fetalis NIHF pregnancies in South China.Methods: We retrospectively reviewed NIHF pregnancies referred to the Fujian Provincial Maternity and Children's Hospital during 2014 and 2018. Pregnancies with maternal alloimmunization were excluded. Thalassemia genotyping and routine karyotyping were performed in all enrolled 129 cases, and chromosomal microarray analysis was performed in 35 cases with normal karyotype. Results: α0/α0 thalassemia was detected in 34.9% (45/129) of the cohort, while chromosomal abnormalities were detected in 29.5% (38/129), including 37 cases of aneuploidy and a single case of imbalanced structural abnormality. In 35 cases with normal karyotype, chromosomal microarray analysis (CMA) revealed no additional pathogenic variations. The rates of chromosomal abnormalities subsided with the onset of trimester, with 65%, 30.1%, and 8.3% in the first, second, and third trimester, respectively (p＜0.05 ). Among 46 (35.6%) cases of unknown etiology, 23 cases accompanied with ultrasonic abnormalities resulted in poor outcome, while 7 cases presented only with multiple ascites that resolved or remitted prior to birth, normal development was observed during 3-4 years follow-up.Conclusion: α0/α0 thalassemia and chromosomal abnormalities are the most common genetic etiologies of NIHF in South China. Generalized skin edema and accompanying ultrasonic abnormalities are predictive of adverse outcomes, and intensive monitoring should be provided to NIHF for better pregnancy management.

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Non‐Immune Hydrops Fetalis: Do Placentomegaly and Polyhydramnios Matter?

Abstract: Compared to NIHF alone, pregnancies with NIHF and P/PM had a lower risk of IUFD and were at increased risk of PTB (<37 and <34 weeks) and spontaneous PTB. This information may help providers in counseling patients with NIHF and supports the need for close antenatal surveillance.

Cited by 13 publications

References 22 publications

Preoperative Cervical Length Predicts the Risk of Delivery within One Week after Pleuroamniotic Shunt in Fetuses with Severe Hydrothorax

Preoperative Cervical Length Predicts the Risk of Delivery within One Week after Pleuroamniotic Shunt in Fetuses with Severe Hydrothorax

Understanding Preterm Birth in Pregnancies Complicated by Nonimmune Hydrops Fetalis

Genetic Disorders and Pregnancy Outcomes of non-immune Hydrops Fetalis in a Tertiary Referral Center

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