OBJECTIVE To analyze the etiology and outcome of fetal ascites in a hospital in a low-resource country. METHODS Data were reviewed for patients with fetal ascites who attended Groote Schuur Hospital, Cape Town, South Africa, from 1 January, 2006, to 31 December, 2009. RESULTS There were 50 cases of fetal ascites. Prenatal investigations included detailed ultrasonography, Doppler studies, TORCH screening and chromosome analysis if amniocentesis was accepted by the patient. The underlying cause was diagnosed prenatally for 41 (82%) cases. The following etiologies were documented: secondary to a genetic cause (n=10); structural fetal abnormality (n=20); congenital syphilis (n=4) or other infection (n=3); fetal environment (n=3); placenta (n=3); and unknown origin (n=7). The perinatal mortality was 72%. Factors predicting a poor prognosis included multiple abnormalities (100% fetal loss), cardiac anomalies (91% loss), hydrops fetalis (80% loss), and infection (71% loss). Ascites of unknown origin and ascites secondary to renal causes had the best prognosis (perinatal loss of 17% and 25%, respectively). CONCLUSIONS The cause, and therefore the prognosis, was identified in 82% of cases of fetal ascites. The prognosis for prenatally diagnosed ascites was poor; however, a few patients did well, which has important implications for genetic counseling.