Prediction of Outcomes in Infants with Hydrops Foetalis by Mode of Delivery: A Retrospective Cohort Study from a Low-Resource Setting

Prediction of Outcomes in Infants with Hydrops Foetalis by Mode of Delivery: A Retrospective Cohort Study from a Low-Resource Setting | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prediction of Outcomes in Infants with Hydrops Foetalis by Mode of Delivery: A Retrospective Cohort Study from a Low-Resource Setting Philippe P. Amubuomombe¹´²‫, Wycliffe K. Kosgei ‬, Philiph Tonui K., and 24 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9252703/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract BACKGROUND : Hydrops foetalis is associated with markedly increased perinatal and neonatal morbidity and mortality. Despite advances in intrauterine interventions and neonatal care, the overall survival rate remains low, with current estimates at approximately 27%. Several risk factors for adverse outcomes have been described; however, there is a paucity of evidence regarding predictive tools that incorporate mode of delivery in estimating perinatal outcomes. OBJECTIVE : This study aimed to evaluate whether caesarean section is associated with improved perinatal outcomes among infants diagnosed with hydrops foetalis using a risk prediction index for low-resource settings. METHODS : This was a retrospective cohort study involving the retrieval and review of 102 medical records of pregnancies complicated by hydrops foetalis between January 2013 and December 2023. All participants underwent transabdominal ultrasound during pregnancy as part of the standard diagnostic protocol for hydrops foetalis. Maternal and neonatal medical records were examined to obtain information regarding outcomes based on mode of delivery, either caesarean section or vaginal birth. The medical records’ findings for all eligible cases were categorised into four classes according to the severity of hydrops foetalis, as determined by obstetric ultrasound: Class I (mild features), Class II (moderate features), Class III (moderately severe features), and Class IV (severe features). Internal validation of the model was performed using receiver operating characteristic (ROC) analysis to assess discrimination and calibration, and Kaplan–Meier survival analysis with log-rank testing to compare neonatal survival across risk groups. Statistical significance was defined as a two-tailed p-value of less than 0.05. RESULTS : In this cohort, a total of 102 medical records of pregnancies complicated by hydrops foetalis were included, with 63 neonatal deaths (61.8%) and 39 survivors (38.2%). Mortality increased significantly with hydrops severity classification (χ² = 10.869, p = 0.009), with 73.0% of deaths occurring in Class IV. Kaplan–Meier analysis demonstrated markedly poorer neonatal survival among high-risk infants, with most deaths occurring within the first 7 days after birth. In contrast, approximately 62% of low/moderate-risk infants survived to the end of follow-up. The proposed risk score demonstrated good discriminative performance in predicting adverse perinatal outcomes (Area Under the Curve = 0.852, 95% CI 0.780–0.923; p < 0.001), with 73.0% sensitivity, 82.1% specificity, 86.8% positive predictive value, and 65.3% negative predictive value at the optimal cutoff. The mode of delivery was not significantly associated with neonatal survival (OR = 1.52, 95% CI 0.68–3.39; p = 0.309). CONCLUSION : Caesarean delivery was not associated with improved neonatal survival among pregnancies complicated by hydrops foetalis. In the absence of specific obstetric indications, vaginal delivery istherefore an appropriate mode of delivery. The prediction of hydrops foetalis infant outcomes by the mode of delivery risk score showed good predictive performance to assist clinicians in risk stratification and mode-of-delivery decision-making, particularly in low-resource settings where advanced foetal interventions are unavailable. Hydrops foetalis Mode of delivery Caesarean section Perinatal outcomes Neonatal survival Predictors Mirror syndrome Vaginal delivery Full Text Additional Declarations No competing interests reported. Table 1 to 8 are available in the Supplementary Files section. Supplementary Files SupplementaryTables.docx Tablesformanuscript.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 03 May, 2026 Reviewers agreed at journal 03 May, 2026 Reviewers invited by journal 21 Apr, 2026 Editor invited by journal 31 Mar, 2026 Editor assigned by journal 29 Mar, 2026 Submission checks completed at journal 29 Mar, 2026 First submitted to journal 28 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9252703","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631136113,"identity":"7f065994-04c4-4eae-a47a-7c7f499d12c6","order_by":0,"name":"Philippe P. 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Despite advances in intrauterine interventions and neonatal care, the overall survival rate remains low, with current estimates at approximately 27%. Several risk factors for adverse outcomes have been described; however, there is a paucity of evidence regarding predictive tools that incorporate mode of delivery in estimating perinatal outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOBJECTIVE\u003c/strong\u003e: This study aimed to evaluate whether caesarean section is associated with improved perinatal outcomes among infants diagnosed with hydrops foetalis using a risk prediction index for low-resource settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS\u003c/strong\u003e: This was a retrospective cohort study involving the retrieval and review of 102 medical records of pregnancies complicated by hydrops foetalis between January 2013 and December 2023. All participants underwent transabdominal ultrasound during pregnancy as part of the standard diagnostic protocol for hydrops foetalis. Maternal and neonatal medical records were examined to obtain information regarding outcomes based on mode of delivery, either caesarean section or vaginal birth. The medical records’ findings for all eligible cases were categorised into four classes according to the severity of hydrops foetalis, as determined by obstetric ultrasound: Class I (mild features), Class II (moderate features), Class III (moderately severe features), and Class IV (severe features). Internal validation of the model was performed using receiver operating characteristic (ROC) analysis to assess discrimination and calibration, and Kaplan–Meier survival analysis with log-rank testing to compare neonatal survival across risk groups. Statistical significance was defined as a two-tailed p-value of less than 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS\u003c/strong\u003e: In this cohort, a total of 102 medical records of pregnancies complicated by hydrops foetalis were included, with 63 neonatal deaths (61.8%) and 39 survivors (38.2%). Mortality increased significantly with hydrops severity classification (χ² = 10.869, p = 0.009), with 73.0% of deaths occurring in Class IV. Kaplan–Meier analysis demonstrated markedly poorer neonatal survival among high-risk infants, with most deaths occurring within the first 7 days after birth. In contrast, approximately 62% of low/moderate-risk infants survived to the end of follow-up. The proposed risk score demonstrated good discriminative performance in predicting adverse perinatal outcomes (Area Under the Curve = 0.852, 95% CI 0.780–0.923; p \u0026lt; 0.001), with 73.0% sensitivity, 82.1% specificity, 86.8% positive predictive value, and 65.3% negative predictive value at the optimal cutoff. The mode of delivery was not significantly associated with neonatal survival (OR = 1.52, 95% CI 0.68–3.39; p = 0.309).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION\u003c/strong\u003e: Caesarean delivery was not associated with improved neonatal survival among pregnancies complicated by hydrops foetalis. In the absence of specific obstetric indications, vaginal delivery istherefore an appropriate mode of delivery. The prediction of hydrops foetalis infant outcomes by the mode of delivery risk score showed good predictive performance to assist clinicians in risk stratification and mode-of-delivery decision-making, particularly in low-resource settings where advanced foetal interventions are unavailable.\u003c/p\u003e","manuscriptTitle":"Prediction of Outcomes in Infants with Hydrops Foetalis by Mode of Delivery: A Retrospective Cohort Study from a Low-Resource Setting","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-30 06:04:42","doi":"10.21203/rs.3.rs-9252703/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-03T19:40:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291477553541506522566096070172273661701","date":"2026-05-03T14:09:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T14:41:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-31T19:46:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-30T00:23:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-30T00:23:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-03-28T12:21:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5126cebf-27b1-47b2-afcd-d005715ae897","owner":[],"postedDate":"April 30th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-03T19:40:18+00:00","index":54,"fulltext":""},{"type":"reviewerAgreed","content":"291477553541506522566096070172273661701","date":"2026-05-03T14:09:07+00:00","index":53,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T06:04:42+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-30 06:04:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9252703","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9252703","identity":"rs-9252703","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}