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. 2023 Jul;40(9):917-922.
doi: 10.1055/a-2008-2495. Epub 2023 Jan 5.

Understanding Preterm Birth in Pregnancies Complicated by Nonimmune Hydrops Fetalis

Kate Swanson  1   2 , Mary E Norton  1   2   3   4 , Sarah L Downum  1 , Juan M Gonzalez-Velez  1   3 , Teresa N Sparks  1   3   4
Affiliations

Understanding Preterm Birth in Pregnancies Complicated by Nonimmune Hydrops Fetalis

Kate Swanson et al. Am J Perinatol. 2023 Jul.

Abstract

Objective: Nonimmune hydrops fetalis (NIHF) is associated with poor perinatal outcomes including preterm birth (PTB). However, the frequency and causes of PTB in this population are not well understood. We hypothesized that NIHF frequently results in PTB due to medically indicated delivery for fetal distress.

Study design: This was a secondary analysis of a prospectively enrolled cohort of pregnancies with NIHF that underwent exome sequencing if standard testing was nondiagnostic. The primary outcome was frequency of PTB at <37 weeks' gestation. Secondary outcomes were reasons for PTB, fetal predictors of PTB, and frequency of neonatal death following PTB.

Results: Fifty-six cases were included, with a median gestational age at delivery of 32.8 weeks (interquartile range [IQR]: 30.3-35.0). Overall, 86% (48/56) were delivered preterm. Among 48 PTBs, 18 (38%) were spontaneous, 9 (19%) were medically indicated for maternal indications (primarily preeclampsia), and 21 (44%) were medically indicated for fetal indications (nonreassuring antenatal testing or worsening effusions). Neither fetal genetic diagnosis nor polyhydramnios was associated with PTB.

Conclusion: More than four-fifths of pregnancies with NIHF result in PTB, often due to nonreassuring fetal status. These data are informative for counseling patients and for developing strategies to reduce PTB in pregnancies with NIHF.

Key points: · Pregnancies complicated by nonimmune hydrops fetalis often result in preterm birth.. · Preterm birth in these cases is most often medically indicated for fetal benefit.. · Fetal genetic conditions and polyhydramnios may be associated with preterm birth in cases of NIHF..

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Inclusion and exclusion of patients in this secondary analysis.
Fig. 2
Fig. 2
Timing and reasons for preterm birth in pregnancies complicated by NIHF. PTB, preterm birth; PPROM, preterm premature rupture of membranes; PTL, preterm labor. 1Includes cases with gestational hypertension, preeclampsia with and without severe features, and atypical preeclampsia. 2Includes nonstress test, biophysical profile, and/or umbilical artery Dopplers.
See this image and copyright information in PMC

References

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