Etiology and Perinatal Outcome of Nonimmune Hydrops Fetalis in Southern China

Abstract

Objective This study aims to analyze the etiology and perinatal outcome of nonimmune hydrops fetalis (NIHF) in Southern China. Methods All cases with NIHF diagnosed antenatally from January 1, 2007 to December 31, 2014 were identified and analyzed. Results Total 482 cases of NIHF were identified during the study period. The most common cause of NIHF was hemoglobin (Hb) Bart's disease (61.8%), followed by chromosomal abnormalities (13.5%), idiopathic etiology (13.1%), cardiac abnormalities (6.4%), and others (5.2%). After 20 weeks' gestation, a total of 408 cases of NIHF presented, including Hb Bart's disease (279 cases), cardiac abnormalities (27 cases), and infection (7 cases). NIHF caused by chromosomal abnormalities mainly presented between 15 and 19 weeks' gestation. Of the 482 cases, 459 cases elected termination of pregnancy. The remaining 23 cases elected to continue their pregnancy. Among them, 14 (60.9%) resulted in intrauterine fetal death, 6 had neonatal death, 3 infants survived to 1 year of age. Of the three infants, one has cerebral palsy, and the remaining two are normal. Conclusions Hb Bart's disease is the most common cause of NIHF in Southern China. An effective prenatal screening and counseling program for thalassemia in this region may be the most effective way to lower the incidence NIHF.

Fetal Anemia in Northern Thailand: Etiologies and Outcomes

“…Hb Bart's disease or homozygous alpha 0 -thalassemia remains the most prevalent cause of fetal anemia in northern Thailand, indicating a high gene frequency of alpha 0 -thalassemia in the population. The leading diagnosis of Hb Bart's disease in our study is consistent with that reported in previous studies in Thailand and China (2,7,13,15). Increasingly, diagnosed causes of fetal anemia are non-deletional alpha-thalassemia and hereditary Fetal anemia in northern Thailand red cell membrane disorders.…”

“…negative blood group (1.7%) compared with that in Western populations (17.3%) (5). The leading cause of fetal anemia among Asian populations is hemoglobin (Hb) Bart's disease resulting from homozygous alpha 0 -thalassemia (2,(6)(7)(8).…”

Non‐immune hydrops fetalis was rare in Sweden during 1997‐2015, but cases were associated with complications and poor prognosis

“…Published data suggest that rates of legal termination may be high following detection of NIHF during pregnancy. In the recent study by He et al, 26 459 (95.2%) out of 482 cases of NIHF detected by ultrasonography during pregnancy ended in spontaneous or legal termination, with only 23 (4.8%) cases continuing to birth. Thus, legal terminations and late miscarriages may contribute to the lower incidence reported here compared with other studies.…”

The many etiologies of nonimmune hydrops fetalis diagnosed by exome sequencing

“…7 The prognosis of the fetus depends on the cause of NIHF and gestational age; perinatal mortality ranges from 55%-98%. [8][9][10] Moreover, identifying the underlying etiology of NIHF is important for managing both the current pregnancy and determining the recurrence risk for future pregnancies.…”