In the name of God

In the name of GodIn the name of God

Hydrops Fetalis

Hydrops = Generalized subcutaneous edema in the fetus or neonate

Definition :

1. Excess serous fluid in at least one space

(ascites, pleural effusion, or pericardial

effusion) + skin edema (> 5 mm thick)

2. Excess fluid in two spaces without edema

Hydrops Fetalis

Non Immune Hydrops Fetalis (90%)

Immune Hydrops Fetalis (10%)

1. Anemia

2. Cardiac failure

3. Fetal Hypoxemia

Pathogenesis

Pathogenesis (cont).

4. Extra vascular protein leakage →

increased capillary permeability →

hypoalbuminemia → Accumulation

of fluid in body cavities

5. Placental perfusion abnormalities

Etiology

1. Hematologic: Due to anemia (10% of cases) :

A. Isoimmune hemolytic disease (RH incompatibility).

B. Hemozygous alphathalassemia

C. Hemozygous G6PD d,

D. Feto maternal hemorrhage - twin - to twin transfusion

E. Bone marrow failure - bone marrow replacement -

leukemia

In RH incompatibility :

• Fetus is RH + / mother is RH –

• Maternal exposure to foreign antigens → IgG

antibodies fetal antigens → destruction of fetal

RBCs → Hemolysis hydrops

fetal anemia → reticulocytosis (Hb<7 g/dL)

→ erythroblastosis.

Against

In severe form

In severe form

In moderate form

2. Cardiovascular: Due to heart failure (20% cases)

A. Rhythm disturbances

B. Major cardiac disease

3. Renal (5% of cases)

Nephrosis, RVT, urinary obstruction

4.Infection (8% of cases)

TORCH-Syphilis-Congenital Hepatitis,

Parvovirus….

5. Pulmonary (5% of cases)

Chylothorax, diaphragmatic hernia ,

intrathoracic mass

6. Placental or cord (rare)

7. Maternal conditions (5% of cases) :

Toxemia, diabetes, thyrotoxicosis

8. Gastrointestinal (5% of cases) :

Meconium peritonitis …..

9. Chromosomal (5% of cases) :

Turner syndrome, trisomy 13,18,21

10. Miscellaneous (10% of cases) :

Cystic hygroma, wilms’ tumor –

teratoma - Neuroblastom

11. Unknown (20% of cases) :

Signs of hydrops :

1. Pericardial & pleural effusions

2. Ascites

3. Skin edema

4. Hepatosplenomegaly

5. Polyhydramnios

6. Placental thickening

Diagnosis :

• Pregnant woman with :

• Polyhydramnios, severe anemia, toxemia, isoimmune

disease → ultrasonic examination → Fluid

accumulation in the fetus or placenta

of circulating maternal antibody → NIHF

In the absence

Post natal Evaluation