Author: Chong D.M.; Mwenechanya S.; Bricker L.; Agarwal U.
Abstract: Introduction Fetal ascites is commonly associated with a number of causes; anemia, infection and aneuploidy being among the causes. Idiopathic massive fetal ascites is however very rare with only a few cases reported in the English literature. Case Study We report a case of a 38-year-old multiparous woman with two term deliveries. She was referred at 16 weeks after a screen positive test for Downs syndrome. After counseling she declined karyotyping. A 20 week anomaly scan showed mild ascites and mild pericardial effusion but no structural anomalies. A detailed fetal cardiac scan was normal as was a viral infection screen. Maternal antibody screen was also negative. By 28 weeks the pericardial effusion had resolved but the ascites was massive with no other signs of fetal hydrops. The middle cerebral artery peak systolic velocity (MCA PSV) was elevated at 54 cm/s. The umbilical artery Doppler, fetal growth and liquor volume were normal. Fetal cardiac echo was normal. Amniocentesis was accepted. Karyotype and microarray were normal, viral screen and cystic fibrosis test was negative. Despite the persistence of
massive ascites, serial ultrasound scans showed reassuringly normal growth and umbilical artery dopplers, with MCA PSV stable at 52-54 cm/ s. After the amniocentesis she developed anti -E antibodies with a titre of 1/3 which was too low to cause anemia. At 33 weeks she went into labour with ruptured membranes, she was therefore delivered after a course of steroids. Birthweight was 2575 g with good Apgar scores. Postnatal ultrasound scans showed moderate ascites and cardiac echocardiogram showed small PDA and PFO, likely secondary to prematurity and no other anomalies. HB was normal. The liver, biliary system, bladder, and hepato-portal vascular flow were all normal. The ascites resolved completely by day 7 and the baby was discharged home at day 17 of life. Conclusion Fetuses with isolated ascites, normal karyotype and negative infection screen carry a good prognosis, with spontaneous resolution of the ascites.
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