Subscribe to RSS
DOI: 10.1055/s-0036-1597269
Isolated Fetal Ascites, Neonatal Outcome in 51 Cases Observed in a Tertiary Referral Center
Publication History
15 May 2016
19 October 2016
Publication Date:
28 November 2016 (online)
![](https://www.thieme-connect.de/media/ejps/201701/lookinside/thumbnails/10-1055-s-0036-1597269_163764oa-1.jpg)
Abstract
Introduction Prenatal detection of isolated ascites is a rare finding on ultrasound, usually suggestive of an underlying pathology that may negatively impact on the pregnancy and neonatal outcome. The purpose of the present study was to evaluate the outcome of primary isolated ascites in relation to gestational age (GA) at diagnosis.
Materials and Methods Data were prospectively collected for fetuses with ascites that have been followed in our center of prenatal diagnosis and therapy from 2004 to 2014. Patients have been divided in group I when ascites was detected before the 24th week of GA and group II if it was noticed later. Prenatal workup included detailed ultrasound, maternal blood group and presence of antibodies, maternal infection screening, fetal karyotyping, and if needed fetal paracentesis. Postnatal data included GA at birth, mode of delivery, weight at birth, neonatal and surgical outcome.
Results During the study period, 51 fetuses were included. Among them, 28 in group I and 23 in group II. An associated anomaly was prenatally identified in 84% of the fetuses. Prenatal demise occurred only in patients belonging to group I for an overall incidence of 10%. An associated disease was confirmed after birth in 61% of cases in group I and in 74% in group II (p = ns). There was a higher incidence of gastrointestinal pathology in group II than in group I (47 vs. 10%, p = 0.004); with a significant prevalence of meconium peritonitis (32 vs. 4%, p = 0.016). Nine patients (17.6%) died after birth, all in group I, because of major systemic malformations. Overall, the postnatal outcome was good in 63% (n = 32) of the cases, and more than half of them belonged to group II (p = 0.003).
Conclusion A wide range of etiologies have been found to be associated with isolated fetal ascites. A systematic diagnostic workup and multidisciplinary prenatal counseling can improve the accuracy of prenatal identification of associated pathologies. The early detection of fetal ascites, before the 24th week of GA, is associated with a significant risk of perinatal death; otherwise, a late diagnosis of fetal ascites is associated with an increased risk of gastrointestinal diseases, especially with meconium peritonitis.
-
References
- 1 El Bishry G. The outcome of isolated fetal ascites. Eur J Obstet Gynecol Reprod Biol 2008; 137 (1) 43-46
- 2 Schmider A, Henrich W, Reles A, Kjos S, Dudenhausen JW. Etiology and prognosis of fetal ascites. Fetal Diagn Ther 2003; 18 (4) 230-236
- 3 Favre R, Dreux S, Dommergues M , et al. Nonimmune fetal ascites: a series of 79 cases. Am J Obstet Gynecol 2004; 190 (2) 407-412
- 4 Nose S, Usui N, Soh H , et al. The prognostic factors and the outcome of primary isolated fetal ascites. Pediatr Surg Int 2011; 27 (8) 799-804
- 5 Boutall A, Urban MF, Stewart C. Diagnosis, etiology, and outcome of fetal ascites in a South African hospital. Int J Gynaecol Obstet 2011; 115 (2) 148-152
- 6 Winn HN, Stiller R, Grannum PA, Crane JC, Coster B, Romero R. Isolated fetal ascites: prenatal diagnosis and management. Am J Perinatol 1990; 7 (4) 370-373
- 7 Bettelheim D, Pumberger W, Deutinger J, Bernaschek G. Prenatal diagnosis of fetal urinary ascites. Ultrasound Obstet Gynecol 2000; 16 (5) 473-475
- 8 Nigro G, La Torre R, Mazzocco M , et al. Multi-system cytomegalovirus fetopathy by recurrent infection in a pregnant woman with hepatitis B. Prenat Diagn 1999; 19 (11) 1070-1072
- 9 Wang CN, Chang SD, Chao AS, Wang TH, Tseng LH, Chang YL. Meconium peritonitis in utero---the value of prenatal diagnosis in determining neonatal outcome. Taiwan J Obstet Gynecol 2008; 47 (4) 391-396
- 10 Zelop C, Benacerraf BR. The causes and natural history of fetal ascites. Prenat Diagn 1994; 14 (10) 941-946
- 11 Jauniaux E, Van Maldergem L, De Munter C, Moscoso G, Gillerot Y. Nonimmune hydrops fetalis associated with genetic abnormalities. Obstet Gynecol 1990; 75 (3 Pt 2): 568-572
- 12 Mueller-Heubach E, Mazer J. Sonographically documented disappearance of fetal ascites. Obstet Gynecol 1983; 61 (2) 253-257
- 13 Machin GA. Diseases causing fetal and neonatal ascites. Pediatr Pathol 1985; 4 (3-4): 195-211
- 14 Aalami OO, Allen DB, Organ Jr CH. Chylous ascites: a collective review. Surgery 2000; 128 (5) 761-778
- 15 Machin GA. Hydrops revisited: literature review of 1,414 cases published in the 1980s. Am J Med Genet 1989; 34 (3) 366-390
- 16 McCoy GD, Resch RC, Racker E. Characterization of dextran sulfate-treated ascites tumor cells and their repair by ascites fluid. Cancer Res 1976; 36 (9 pt.1): 3339-3345
- 17 Società Italiana di Ecografia Ostetrico Ginecologica (SIEOG). Linee Guida SIEOG ed. Nov. 2015, EDITEAM edition: 2015
- 18 Corteville JE, Gray DL, Langer JC. Bowel abnormalities in the fetus--correlation of prenatal ultrasonographic findings with outcome. Am J Obstet Gynecol 1996; 175 (3 Pt 1): 724-729
- 19 Smith RP, Illanes S, Denbow ML, Soothill PW. Outcome of fetal pleural effusions treated by thoracoamniotic shunting. Ultrasound Obstet Gynecol 2005; 26 (1) 63-66