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Hydrops fetalis is the accumulation of two or more fetal fluid collections, including pericardial effusion, pleural effusion(s), ascites and skin oedema. In the absence of red cell alloimmunisation, hydrops fetalis is nonimmune and affects approximately 1 in 2000 pregnancies. Non-immune hydrops fetalis (NIHF) is associated with severe perinatal morbidity/mortality and significant maternal risks, including maternal mirror syndrome. Priorities for clinicians are determining the cause antenatally to optimise management and discuss treatment options, if available. Systematic reviews have indicated that a cause can be identified prenatally in ~60% cases. Recent evidence indicates fetal exome sequencing can provide a diagnosis in 30% of previously unexplained cases. Learning objectivesTo understand causes of NIHF and its association with perinatal and maternal morbidity and mortality To appreciate the basis for investigations for NIHF, including exome sequencing To understand how care can be effectively shared by referring units and tertiary fetal medicine units

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Objective: We aimed to determine foetal losses for DCDA and MCDA twins following transabdominal CVS or amniocentesis performed <22+ 0 weeks. Methods:Retrospective cohort study conducted in the UK and Belgium 01/01/00-01/06/20. Cases with unknown chorionicity, monochorionic complications or complex procedures were excluded. Uncomplicated DCDA and MCDA twins without invasive procedures were identified as controls. We reported foetal losses <24 + 0 weeks and losses of genetically and structurally normal foetuses. Results:Outcomes were compared for DCDA foetuses; 258 after CVS with 3406 controls, 406 after amniocentesis with 3390 controls plus MCDA foetuses, 98 after CVS with 1124 controls, and 160 after amniocentesis with 1122 controls. There were more losses <24+ 0 weeks with both procedures in DCDA (CVS RR 5.54 95%