Surgically correctable fetal hydrops.

Hydrops fetalis is classically the result of immune mediated intrauterine hemolysis. Increasingly, however, nonimmunologic abnormalities have been associated with fetal anasarca. A number of these are potentially surgically correctable. Four such infants have been treated at the Arkansas Children's Hospital since 1981. Fetal hydrops was detected prenatally in three, as well as lesions which might be corrected. All three were delivered by cesarean section with vigorous resuscitation required. Following stabilization, each underwent operation with excision of an intrathoracic mass (teratoma and leiomyosarcoma) in two and closure of omphalocele in the remaining neonate. A fourth infant was transferred following spontaneous premature vaginal delivery with hydrops and respiratory distress. This was associated with adenomatoid malformation which was subsequently excised. Anasarca and respiratory distress resolved postoperatively in all. With evidence of nonimmune hydrops, a thorough evaluation for surgically correctable lesions is indicated. A planned aggressive approach to delivery, resuscitation and stabilization followed by prompt surgical intervention can improve the morbidity associated with nonimmune hydrops fetalis having surgically correctable malformations.