Table 1.

Protocol for diagnostic workup of fetal ascites

Initial visit

Maternal blood

Blood group, indirect Coombs test

Infection screening - complete blood count, torch IgM and IgG, viral markers

SS-A, SS-B antibodies (in cases of fetal bradyarrhythmia)

Hb electrophoresis

Ultrasound

Detailed anatomy survey for anomalies and soft marker for aneuploidies

Fetal echocardiography

Fetal Doppler (including MCA PSV)

Measurement of amniotic fluid index

Invasive testing

Amniotic fluid

FISH and/or karyotype (or microarray analysis 2014 onwards)

PCR for torch infections

DNA storage for genetic mutation analysis in selected cases

Cystic fibrosis - common mutation (in cases of intra-abdominal calcifications)

Ascitic fluid*

Cytology

PAS staining (in cases with hepatomegaly)

Protein/albumin

Beta 2 microglobulin (in cases where urinary ascites was suspected)

Perinatal autopsy in selected cases

Follow-up every 2-4 week by ultrasound

*Tapped when ascitic fluid was significant enough to cause thoracic compression and in one case due to oligoamnios as substitute for amniotic fluid. Ig: Immunoglobulin, MCA: Middle cerebral arterial, PSV: Peak systolic velocity, FISH: Fluorescence in situ hybridization, PCR: Polymerase chain reaction, Hb: Hemoglobin, PAS: Periodic acid-Schiff