Abstract
Objective
To describe the current investigation and management of non-immune fetal hydrops with
a focus on treatable or recurring etiologies.
Outcomes
To provide better counselling and management in cases of prenatally diagnosed non-immune
hydrops.
Evidence
Published literature was retrieved through searches of PubMed or MEDLINE, CINAHL,
and The Cochrane Library in 2017 using key words (non-immune hydrops fetalis, fetal
hydrops, fetal therapy, fetal metabolism). Results were restricted to systematic reviews,
randomized controlled trials/controlled clinical trials, observational studies, and
significant case reports. Additional publications were identified from the bibliographies
of these articles. There were no date or language restrictions. Searches were updated
on a regular basis and incorporated in the guideline to September 2017. Grey (unpublished)
literature was identified through searching the websites of health technology assessment
and health technology-related agencies, clinicalpractice guideline collections, clinical
trial registries, and national and international medical specialty societies.
Benefits, Harms, and Costs
These guidelines educate readers about the causes of non-immune fetal hydrops and
its prenatal counselling and management. It also provides a standardized approach
to non-immune fetal hydrops, emphasizing the search for prenatally treatable conditions
and recurrent genetic etiologies.
Values
The quality of evidence in this document was rated using the criteria described in
the Report of the Canadian Task Force on Preventive Health Care.
Recommendations
- 1.All patients with fetal hydrops should be referred promptly to a tertiary care centre for evaluation. Some conditions amenable to prenatal treatment represent a therapeutic emergency after 18 weeks, allowing prolongation of pregnancy with improved fetal/neonatal outcomes (II-2A).
- 2.Fetal chromosome analysis through array comparative genomic hybridization (microarray) molecular testing should be offered where available in all cases of non-immune fetal hydrops (II-2A).
- 3.Imaging studies should include comprehensive obstetrical ultrasound (including arterial and venous fetal Doppler) and fetal echocardiography (II-2A).
- 4.Investigation for maternal–fetal infections and alpha-thalassemia in women at risk because of their ethnicity should be performed in all cases of unexplained fetal hydrops (II-2A).
- 5.To evaluate the risk of fetal anemia, Doppler measurement of the middle cerebral artery peak systolic velocity should be performed in all hydropic fetuses after 16 weeks of gestation. In case of suspected fetal anemia, fetal blood sampling and intrauterine transfusion should be offered rapidly (II-2A).
- 6.All cases of unexplained fetal hydrops should be referred to a medical genetics service where available. Detailed postnatal evaluation by a medical geneticist should be performed on all cases of newborns with unexplained non-immune hydrops (II-2A).
- 7.Autopsy is strongly recommended for all cases of fetal or neonatal death for which no diagnosis is reached prenatally (II-2A).
Key Words
Abbreviations:
AF (amniotic fluid), CBC (complete blood count), CMV (cytomegalovirus), DNA (deoxyribonucleic acid), ELISA (enzyme-linked immunosorbent assay), FISH (fluorescent in situ hybridization), GA (gestational age), Hb (hemoglobin), HbH (hemoglobin H), HIV (human immunodeficiency virus), IgG (immunoglobulin G), IgM (immunoglobulin M), MCA (middle cerebral artery), MPS (mucopolysaccharidosis), NIHF (non-immune hydrops fetalis), QF-PCR (quantitative fluorescent polymerase chain reaction), RT-PCR (real-time polymerase chain reaction), SOGC (Society of Obstetricians and Gynaecologists of Canada), TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes simplex), UA (umbilical artery)To read this article in full you will need to make a payment
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Article info
Publication history
No. 363, August 2018 (Replaces No. 297, October 2013)
Footnotes
This document reflects emerging clinical and scientific advances on the date issued, and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
Patients have the right and responsibility to make informed decisions about their care in partnership with their health care providers. To facilitate informed choice, women should be provided with information and support that is evidence based, culturally appropriate, and tailored to their needs. The values, beliefs, and individual needs of each patient and their family should be sought, and the final decision about the care and treatment options chosen by the patient should be respected.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
