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In the name of God. Hydrops Fetalis. Hydrops = Generalized subcutaneous edema in the fetus or neonate. Definition : Excess serous fluid in at least one space (ascites, pleural effusion, or pericardial effusion) + skin edema (> 5 mm thick) Excess fluid in two spaces without edema. - PowerPoint PPT Presentation
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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