Hydrops
Objectives
What is hydrops fetalis ?
What causes hydrops fetalis ?
Who is affected by hydrops
fetalis ?
What are the symptoms of
hydrops fetalis ?
Why is hydrops fetalis a
concern ?
How is hydrops fetalis diagnosed ?
Treatment for hydrops fetalis :
What is hydrops fetalis ?
• Hydrops fetalis is a severe, life-threatening problem of
severe edema (swelling) in the fetus and newborn. It is also
called hydrops.
• Presence of excess extra-cellular fluid in two or
more
sites
Pericardial effusion
Pleural Effusion
Ascites
Placental Enlargement
Non-immune Hydrops Fetalis
What causes hydrops
fetalis?
• Hydrops develops when too much fluid leaves the
bloodstream and goes into the tissues. Many different
diseases and complications can cause hydrops, including the
following:
• Immune:
• Hydrops can develop as the baby's organs are
unable to compensate for the anemia. The heart begins
to fail and large amounts of fluid build up in the baby's
tissues and organs.
What causes hydrops
fetalis• non-immune
? :
includes all other diseases or complications that may interfere
with the baby's ability to manage fluid. There is no one
mechanism to explain non-immune hydrops. Some of the
diseases or complications that are often associated with
hydrops include the following:
• severe anemias
• congenital infections (infections present at birth)
• heart or lung defects
• chromosomal abnormalities and birth defects
• liver disease
• renal disease
Pathogenesis
• Three main hypothesis:
Anemia
C a r d i a c Failure
R e d u c t i o n in Osmotic Pressure
(Hypoproteinaemia
Pathogenesis
• Fetal Anemia:
High output cardiac failure
Increase in umbilical venous pressure
Portal hypertension in severely effected
fetuses due to increase in hepatic
erythropoetic tissue.
Hypoxia and acidosis predispose to epithelial
damage in capillaries that allows loss of fluid
to extravascular comp
Pathogenesis
• Fetal Anemia:
Alpha ( ) Thalasaemia
Secondary to Feto-maternal Hemorrhage
Twin-twin transfusion
Other Hemoglobinopathies
Pathogenesis
Cardiac Failure:
Commonest Mechanism
Increase in Cardiac Size
Increased Fetal Venous Pressure
Causes include:
Cardiomyopathies
Tachyarythmias
Bradycardias
(Congenital heart
block)
Obstructive left
heart disease
Pathogenesis
Reduced Osmotic pressure:
Hypoproteiaemia with Subsequent
Reduction in Osmotic Pressure
Anemia Along With Destruction of Hepatic
Architecture
Congenital Nephrosis
Pathogenesis
• Other :
Obstruction to venous return
Congenital cystic adenomatoid
malformation of
lung
Impaired lymphatic drainage
Cystic hygroma
Karyotypic abnormalities (45XO)
Connective tissue malformation
Fetal Infections:
TORCH
Parvo Virus B19
Who is affected by hydrops fetalis?
• Immune hydrops is not as common
• Non-immune hydrops occurs rarely.
• The incidence of hydrops can vary between populations
Why is hydrops fetalis a concern?
• About half of unborn babies with hydrops do not survive
• Risks are also high for babies born with hydrops, with
survival often depending on the cause and treatment.
What are the symptoms of hydrops fetalis?
• During pregnancy, symptoms may include:
large amounts of amniotic fluid
thickened placenta
ultrasound of the fetus shows enlarged liver, spleen, or
heart, and fluid buildup in the fetus' abdomen
• After birth, symptoms may include:
pale coloring
severe edema overall, especially in the baby's
abdomen
enlarged liver and
spleen respiratory
distress
How is hydrops fetalis diagnosed?
• complete medical history and physical examination
• diagnostic procedures for hydrops fetalis may include:
• Ultrasound
• fetal blood sampling
• amniocentesis
• Fetal echo
• Placental thickness
Treatment for hydrops fetalis:
• based on:
• gestational age, overall health, and medical
history
• Extent of the disease
• Treatment of hydrops depends on the cause
• help for respiratory distress
• removal of excessive fluid from spaces
• medications to help the kidneys remove excess
fluid
Soft
Tissue
shadow
and
pleural
effusion
in
hydropic
neonate
• Thank
