Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2026
Invasive in-utero cardiac intervention in the hydropic fetus may improve survival: results from the International Fetal Cardiac Intervention Registry (IFCIR).
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Moon-Grady A J, Tulzer A, Armstrong A K, Cruz-Martinez R, Cuneo B, Dangel J, Galindo A, Gardiner H, Gelehrter S, Gembruch U, Grinenco S, Haak M, Herberg U, Kilby M D, Malekzadeh-Milani S, Mellander M, Morris S A, Otaño L, Pruetz J, Strainic J, Texter K, Tulzer G, Vigneswaran T, Wilkins-Haug L, IFCIR Collaborators
Аннотация
OBJECTIVE: To describe the pregnancy and postnatal outcomes of a large, retrospectively analyzed case-cohort series of pregnancies complicated by congenital heart disease (CHD) and fetal hydrops that were assessed for potential for fetal cardiac intervention (FCI).
METHODS: The International Fetal Cardiac Intervention Registry (IFCIR) collects diagnostic and procedure-related data on maternal-fetal dyads with CHD that are considered by fetal specialists to be potentially capable of benefiting from FCI, with data submitted voluntarily by local institutions. For this retrospective analysis, the IFCIR database was searched for all case entries of pregnancies with a diagnosis of CHD and coexistent non-immune fetal hydrops, defined as abnormal fluid or edema involving at least two compartments, between January 2001 and September 2024. Data on the underlying cardiac diagnosis, procedures performed and pregnancy and postnatal outcomes were collated.
RESULTS: At the time of data extraction, the IFCIR contained 864 recorded maternal-fetal dyads, of which 91 (10.5%) had fetal hydrops at initial evaluation. Of these, 73 (80.2%) underwent FCI, including aortic (n = 61) or pulmonary (n = 5) balloon valvuloplasty, atrial septal intervention and/or stent placement (n = 4) and other FCI (n = 3), at a median gestational age of 28.3 (range, 19.6-34.7) weeks. The overall rate of procedure-related fetal loss was 20.5% (15/73). There were an additional 10 intrauterine fetal deaths, and two cases were either terminated (n = 1) or lost to follow-up (n = 1). Overall, 21 neonates were liveborn preterm (< 37 weeks) and 25 were liveborn at term (≥ 37 weeks), with a median latency post-procedure to delivery of 8.9 (range, 0.3-18.4) weeks. Of the 73 cases that underwent FCI, 26 (35.6%) survived to first hospital discharge, including 39.3% (24/61) of patients who underwent aortic valvuloplasty, one patient who underwent atrial septal intervention and one patient who underwent pulmonary valvuloplasty. The majority of survivors had biventricular circulation (15/20 with available outcome) at the last follow-up. No procedure-related maternal complications were recorded. Only 1/18 patients managed expectantly without FCI survived to hospital discharge.
CONCLUSIONS: Our findings suggest a potential benefit of FCI in patients with hydrops, although the procedure-related loss rate of 1 in 5 was significant. While the survival rate was lower than that reported in non-hydropic cohorts with FCI, approximately one-third of hydropic fetuses that underwent FCI included in our analysis survived to hospital discharge. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
METHODS: The International Fetal Cardiac Intervention Registry (IFCIR) collects diagnostic and procedure-related data on maternal-fetal dyads with CHD that are considered by fetal specialists to be potentially capable of benefiting from FCI, with data submitted voluntarily by local institutions. For this retrospective analysis, the IFCIR database was searched for all case entries of pregnancies with a diagnosis of CHD and coexistent non-immune fetal hydrops, defined as abnormal fluid or edema involving at least two compartments, between January 2001 and September 2024. Data on the underlying cardiac diagnosis, procedures performed and pregnancy and postnatal outcomes were collated.
RESULTS: At the time of data extraction, the IFCIR contained 864 recorded maternal-fetal dyads, of which 91 (10.5%) had fetal hydrops at initial evaluation. Of these, 73 (80.2%) underwent FCI, including aortic (n = 61) or pulmonary (n = 5) balloon valvuloplasty, atrial septal intervention and/or stent placement (n = 4) and other FCI (n = 3), at a median gestational age of 28.3 (range, 19.6-34.7) weeks. The overall rate of procedure-related fetal loss was 20.5% (15/73). There were an additional 10 intrauterine fetal deaths, and two cases were either terminated (n = 1) or lost to follow-up (n = 1). Overall, 21 neonates were liveborn preterm (< 37 weeks) and 25 were liveborn at term (≥ 37 weeks), with a median latency post-procedure to delivery of 8.9 (range, 0.3-18.4) weeks. Of the 73 cases that underwent FCI, 26 (35.6%) survived to first hospital discharge, including 39.3% (24/61) of patients who underwent aortic valvuloplasty, one patient who underwent atrial septal intervention and one patient who underwent pulmonary valvuloplasty. The majority of survivors had biventricular circulation (15/20 with available outcome) at the last follow-up. No procedure-related maternal complications were recorded. Only 1/18 patients managed expectantly without FCI survived to hospital discharge.
CONCLUSIONS: Our findings suggest a potential benefit of FCI in patients with hydrops, although the procedure-related loss rate of 1 in 5 was significant. While the survival rate was lower than that reported in non-hydropic cohorts with FCI, approximately one-third of hydropic fetuses that underwent FCI included in our analysis survived to hospital discharge. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.