Hydrops

Dr. Tarek Sayed

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

Cardiac Failure

Reduction 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

Ebstien’s anomaly

Atrial isomerism

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 fluidthickened placentaultrasound 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 you