Objective To describe the aetiologies and outcomes of pregnancies complicated by hydrops fetalis (HF).

Study design Case series of all pregnancies complicated by HF managed at The Royal Women’s Hospital (RWH), Melbourne, Australia, between 2001 and 2012. Multiple pregnancies, and cases where antenatal care was not provided at RWH were excluded. Cases were identified from neonatal and obstetric databases. Data were extracted from maternal and neonatal case files, electronic pathology and radiology reports, and obstetric and neonatal databases.

Results Over 12 years, 131 fetuses with HF with a median (IQR) gestational age (GA) at diagnosis of 24 (20–30) weeks were included in the analysis. There were 65 liveborn infants with a median (IQR) GA at birth of 33 (31–37) weeks and a median (IQR) birthweight Z-score of 1.4 (0.4–2.2). Overall survival from diagnosis was 27% (36/131) increasing to 55% (36/65) if born alive.

Conclusions The perinatal mortality risk for fetuses and newborn infants with HF is high with important differences dependent on underlying diagnosis and the time at which counselling is provided. Clinicians need to be aware of the outcomes of both fetuses and neonates with this condition.