**5. Management of NIFH**

Transfer to maternal and fetal medicine unit is recommended. The outcome for most cases of NIFH is poor unless there is a treatable cause. Women are not only extensively counseled [28] regarding outcomes with NIFH, but also for risks such as polyhydramnios (29%) and preterm labour (66%). When there is an ongoing maternal symptom with severe polyhydramnios, amniodrainage is recommended.

The outcome usually falls into


 When NIFH is identified before viability with no identifiable cause, pregnancy termination should be discussed and offered. Termination of pregnancy should be considered when associated with maternal complications such as maternal mirror syndrome. Antepartum surveillance is usually recommended depending on gestational age at diagnosis and the underlying cause of NIFH. Once the underlying cause of fetal hydrops is treated, ongoing surveillance is important to plan delivery. Mode of delivery depends on underlying etiology, gestational age, and maternal well-being. Vaginal delivery is considered when there is a lethal condition with no fetal monitoring. Cesarean delivery is recommended in all other conditions. When there is moderate to severe pleural effusion, drainage prior to delivery may help in the neonatal period. Elective preterm delivery is not recommended unless indicated, as this does not improve neonatal outcomes.

In a recent review of a 12-year retrospective cohort from a single centre [9], the overall survival from diagnosis was 27% increasing to 55% if born alive.

The long-term prognosis of survivors of NIFH also depends on underlying etiology. Following parvovirus B19 infection with fetal anemia and transfusion, there appears to be some neurological sequelae in about 30% of babies [29]. This could be a direct consequence of parvovirus infection with fetal anemia or transfusion.

 Fetuses with supraventricular tachycardia, some babies may develop Wolf Parkinson White syndrome later in life [30].
