Fetal Hydrops and Heart Failure

The recognition of fetal hydrops dates to at least a century ago. This chapter will first review the epidemiology and pathophysiology of fetal hydrops. Given the wide spectrum of causes that lead to fluid imbalances in the fetus, the chapter will focus on the cardiac etiologies which are the most common cause of nonimmune hydrops fetalis, followed by a thorough review of appropriate evaluation including fetal echocardiography to guide the frequency of surveillance and need for treatments based on current guidelines. Echocardiographic findings that establish the diagnosis of hydrops will also be reviewed. Lastly, there will be a discussion of fetal interventions, delivery preparation in fetal hydrops, and findings that are associated with poor outcomes.