Fetal Ascites: Its Prenatal Management and Postnatal Outcome

To report a single tertiary center experience in the management of prenatally diagnosed cases of fetal ascites and their postnatal outcomes.

Prenatally diagnosed fetal ascites cases were retrospectively analyzed from 2015 to 2022 using two-dimensional ultrasound with other investigations as required in a tertiary care center.

Of 126 fetuses with fetal ascites, 70 progressed to hydrops and hence were excluded from the study. Out of the 56 that formed the study group, the median gestational age at presentation was 27.2 weeks (range 15 + 5 to 36 + 4 weeks). A majority (76.8%, 43/56) of ascites had a secondary etiology (secondary ascites) that was identified antenatally (including twin-to-twin transfusion syndrome (TTTS), fetal growth restriction (FGR), fetal anemia, structural cause involving genitourinary, gastrointestinal, cardiovascular system, pulmonary tract and multi-system anomalies), while 23.2% (13/56) were classified as idiopathic ascites where no cause could be determined prenatally. The overall survival rate was 77.4% (24/31) with 41.9% (13/31) needing intervention and 35.5% (11/31) showing spontaneous resolution. 63.6% (7/11) of idiopathic ascites cases had favorable outcomes compared to secondary ascites (17/41, 41.5%).

Fetuses with idiopathic ascites with normal karyotype and negative infection screening demonstrated a higher tendency for spontaneous resolution with a favorable outcome than secondary ascites. However, parents should be informed of the possibility of unexpected rare syndromes/structural abnormalities that may be detected after birth. In cases with secondary ascites, postnatal outcomes could be improved post-intervention. Multidisciplinary team involvement is necessary for the appropriate management and successful outcomes.