TY - CHAP M1 - Book, Section TI - Nonimmune Hydrops Fetalis A1 - Bianchi, Diana W. A1 - Crombleholme, Timothy M. A1 - D'Alton, Mary E. A1 - Malone, Fergal D. PY - 2015 T2 - Fetology: Diagnosis and Management of the Fetal Patient, 2e AB - Key PointsNonimmune hydrops fetalis is a serious fetal condition in which abnormal fluid accumulates in at least two different fetal compartments, and in which circulating antibodies against red-cell antigens are absent in the mother.Nonimmune hydrops fetalis is a heterogeneous disorder, caused by a large number of underlying pathologic processes. While the majority of cases appear to be idiopathic, the most common recognizable cause is cardiovascular pathology.Following the sonographic detection of hydrops, the most important step is to differentiate between immune and nonimmune causes. Once immune causes are excluded, a detailed anatomical survey is needed to rule out congenital abnormalities, which could be the cause of the hydrops.Nonimmune hydrops can occur secondary to fetal anatomical abnormalities (cardiac, thoracic, gastrointestinal, neurologic, genitourinary, vascular, or skeletal), placental/cord abnormalities, fetal hematologic, neoplastic or metabolic disorders, infection, fetal genetic anomalies, and maternal abnormalities.Maternal blood tests should include an indirect Coombs antibody screen, maternal blood type, Kleihauer–Betke stain, complete blood count with differential and erythrocyte indices, hemoglobin electrophoresis, and glucose-6-phosphate dehydrogenase deficiency screen. Additional maternal blood work should include TORCH titers, syphilis screen, and parvovirus B19 IgG and IgM titers.Fetal echocardiography and invasive testing for fetal karyotype should be offered.While the optimal mode of delivery is uncertain, cesarean section is advised for all potentially viable fetuses due to the risk for soft-tissue dystocia.Fetal therapy may be possible, including PUBS with transfusion, maternal administration of cardiac medications, and fetal shunt placement.The long-term prognosis will depend on the nature of the underlying abnormality.The recurrence risk will depend on the underlying etiology of the nonimmune hydrops. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - obgyn.mhmedical.com/content.aspx?aid=1106401776 ER -