The many faces of hydrops

S. Christopher Derderian, Cerine Jeanty, Shannon R. Fleck, Lily S. Cheng, Shabnam Peyvandi, Anita J. Moon-Grady, Jody Farrell, Shinjiro Hirose, Juan Gonzalez, Roberta L. Keller, Tippi C. MacKenzie

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Purpose: Fetal hydrops arises from multiple disease processes and can portend a grim prognosis. We reviewed our experience with hydropic fetuses to understand relevant antenatal anatomic and physiologic predictors of survival. Methods: Wereviewed fetal ultrasounds and echocardiograms of hydropic fetuses evaluated from 1996 to 2013. Results: Overall neonatal survival in 167 fetuses was 44% (range, 0-75%) and was influenced by the underlying disease process. The anatomic distribution of fluid varied and was not significantly different between survivors and nonsurvivors. Univariate analysis indicated that resolution of hydrops and delivery at a later gestational age were predictive of survival (OR: 5.7 (95% CI: 2.5-13.2) and OR: 1.3 (95% CI: 1.1-1.4), respectively). Fetal intervention also improved survival in some diseases. Echocardiograms were reviewed to group fetuses with similar cardiac physiology and defined categories with high or low/normal cardiothoracic ratio (CTR). Among patients with a high CTR, the cardiovascular profile score was predictive of survival (p =0.009). Conclusion: Survival in hydrops depends on the underlying disease, available fetal therapies to resolve hydrops, and the gestational age of delivery and not on the specific anatomic manifestations of hydrops. In hydropic fetuses with high CTRs, the cardiovascular profile score may be a useful prognostic indicator.

Original languageEnglish (US)
Pages (from-to)50-54
Number of pages5
JournalJournal of Pediatric Surgery
Volume50
Issue number1
DOIs
StatePublished - Jan 1 2015

Keywords

  • Cardiovascular profile score
  • Fetal echocardiography
  • Fetal ultrasonography
  • Hydrops
  • Hydrops fetalis

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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    Derderian, S. C., Jeanty, C., Fleck, S. R., Cheng, L. S., Peyvandi, S., Moon-Grady, A. J., Farrell, J., Hirose, S., Gonzalez, J., Keller, R. L., & MacKenzie, T. C. (2015). The many faces of hydrops. Journal of Pediatric Surgery, 50(1), 50-54. https://doi.org/10.1016/j.jpedsurg.2014.10.027