Comprehensive ultrasound, MCA Doppler, fetal echocardiogram

Matemal treatment with digoxin ± flecainide/sotalol

Unilateral pleural effusion or cystic thoracic mass with mediastinal shift

Solid thoracis mass or sacrococcygeal teratoma

Maternal history of previous hydropic offspring or consanguinity

Consider cordocentesis with blood ready for IUT (confirm parvovirus with PCR on amniotic fluid at entry)

Amniocentesis
• FISH
• Karyotype culture
• PCR for tocoplasmosis, cytomegalovirus, enterovirus, adenovirus
• Amniotic fluid mucopolysaccharide and neuraminic acid levels
• Cultured amniocytes for β-glucuronidase, β-glucosidase, β-galactosidase

Add cultured amniocyte assays for enzyme assays for:
• Niemann—Pick A and C
• Wolman
• Faber
• Mucolipidosis II
• Multiple Sulfatase deficiency

Prenatal Evaluation (Alive Fetus)• Maternal history• Maternal blood group (Rh)• Fetal echocardiogram• MCA PSV Doppler• Amniotic fluid analysis (viral PCR, karyotype, FISH, CMA)• Comprehensive obstetrical ultrasound, MRI

Prenatal Evaluation (Intrauterine Demise)• Autopsy (+placenta)• Fetal DNA• Fibroblast culture• Skeletal survey• Immunohistochemical studies• Photographs• Frozen tissues

Postnatal Evaluation (Alive Newborn)• ECG and Echo• Ultrasound: Head and abdomen• Genetic studies• Viral PCR for parvo• CBC and PBF• Total protein and albumin• Kleihauer-Betke test/ flow cytometry of maternal blood• Blood type + direct Coombs test*• Electrolytes• Urinalysis• Analysis of fluid (ascites, pleural effusion)• Renal and liver functions• Radiographs

Postnatal Evaluation (Neonatal Demise)• Autopsy (+placenta)• DNA• Fibroblast culture• Skeletal survey• Immunohistochemical studies• Photographs• Frozen tissues—liver, skin, heart, brain

hydrops