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Article Type

Letter to the Editor

Abstract

With reference to the interesting case report by Aliyu [1], I do agree with the author that nonimmune hydrops fetalis (NIHF) is increasingly considered on the expense of immune hydrops fetalis due to the greater awareness among the general public and medical personnel on Rh alloimmunization, advance in detection and diagnosis, and administration of anti‑D to Rh‑negative pregnant women. In fact, the issue of NIHF has been extensively studied worldwide. Importantly, NIHF, due to causes other than Rh alloimmunization, is the cause in more than 85% of all affected individuals [2]. A recently published systematic literature review, using all publications between 2007 and 2013, has addressed 14 classification groups based on the cause of NIHF (% of the total group): cardiovascular (20.1%), hematologic (9.3%), chromosomal (9.0%), syndromic (5.5%), lymphatic dysplasia (15.0%), inborn errors of metabolism (1.3%), infections (7.0%), thoracic (2.3%), urinary tract malformations (0.9%), extrathoracic tumors (0.7%), placental (4.1%), gastrointestinal (1.3%), miscellaneous (3.6%), and idiopathic (19.8%) [2]. Published data from Nigeria pointed out that fetal cardiac anomalies are the most common cause of NIHF followed by chromosomal anomalies [3]. I agree with the author in the assumption that cyanotic congenital heart disease ought to be considered in the case in question. It is worthy to mention that fetal arrhythmias are detected in at least 2% of the unselected pregnancies during routine obstetrical scans. Most common are transient, brief episodes of a slow or fast heart rate or of an irregular heart rhythm. Less common are prolonged or persistent abnormalities such as supraventricular tachycardia and complete heart block, which may lead to low cardiac output, fetal hydrops, and death [4]. I, therefore, presume that nonstructural cardiac etiology in terms of fetal arrhythmia ought to be considered in the case in question. Unfortunately, the lack of proper antenatal care visits for the mother and nonconduction of chest radiograph, ECG, and echocardiography for the neonate after birth and autopsy after the neonate has succumbed have rendered futile the identification of the exact etiology of NIHP in the case in question.

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