Hydrops fetalis

(Redirected from Fetal hydrops)
Jump to navigation Jump to search

For patient information, click here

Template:DiseaseDisorder infobox

WikiDoc Resources for Hydrops fetalis

Articles

Most recent articles on Hydrops fetalis

Most cited articles on Hydrops fetalis

Review articles on Hydrops fetalis

Articles on Hydrops fetalis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Hydrops fetalis

Images of Hydrops fetalis

Photos of Hydrops fetalis

Podcasts & MP3s on Hydrops fetalis

Videos on Hydrops fetalis

Evidence Based Medicine

Cochrane Collaboration on Hydrops fetalis

Bandolier on Hydrops fetalis

TRIP on Hydrops fetalis

Clinical Trials

Ongoing Trials on Hydrops fetalis at Clinical Trials.gov

Trial results on Hydrops fetalis

Clinical Trials on Hydrops fetalis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Hydrops fetalis

NICE Guidance on Hydrops fetalis

NHS PRODIGY Guidance

FDA on Hydrops fetalis

CDC on Hydrops fetalis

Books

Books on Hydrops fetalis

News

Hydrops fetalis in the news

Be alerted to news on Hydrops fetalis

News trends on Hydrops fetalis

Commentary

Blogs on Hydrops fetalis

Definitions

Definitions of Hydrops fetalis

Patient Resources / Community

Patient resources on Hydrops fetalis

Discussion groups on Hydrops fetalis

Patient Handouts on Hydrops fetalis

Directions to Hospitals Treating Hydrops fetalis

Risk calculators and risk factors for Hydrops fetalis

Healthcare Provider Resources

Symptoms of Hydrops fetalis

Causes & Risk Factors for Hydrops fetalis

Diagnostic studies for Hydrops fetalis

Treatment of Hydrops fetalis

Continuing Medical Education (CME)

CME Programs on Hydrops fetalis

International

Hydrops fetalis en Espanol

Hydrops fetalis en Francais

Business

Hydrops fetalis in the Marketplace

Patents on Hydrops fetalis

Experimental / Informatics

List of terms related to Hydrops fetalis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]

Overview

Hydrops Fetalis indicates an excessive accumulation of interstitial fluid in extravascular compartments and body cavities which is characterized by generalized skin edema, ascites, pleural, or pericardial effusion, and placental enlargement. It may be classified into two groups based on the presence or absence of rhesus iso-immunization. Although Rh disease is the major cause of immune-mediated hydrops fetalis, with the decreased prevalence of Rh disease, non-immune causes (eg, cardiovascular diseases, chromosomal abnormalities, lymphatic anomalies, hematologic diseases, etc.) are responsible in the majority of cases. Screening for Rh(D) incompatibility by Rh(D) blood typing and antibody testing are strongly recommended for all pregnant women during their first visit for pregnancy-related care. Also repeated Rh(D) antibody testing for all unsensitized Rh(D)-negative women at 24 to 28 weeks gestation is recommended unless the biological father is known to be Rh(D) negative. Prognosis is generally poor, and the mortality rate of patients with non-immune hydrops fetalis (NIHF) is approximately 43.2% at 1 year of age, and the presence of either large birth weight, polyhydramnios, or prematurity are associated with a particularly poor prognosis among patients. Ultrasound may be helpful in the diagnosis of hydrops fetalis. Findings on ultrasound suggestive of hydrops fetalis include increased skin thickness (indicative of generalized skin edema), increased placental thickness (indicative of placental edema), polyhydramnios, ascites, pleural effusion, and pericardial effusion. Detailed evaluation and resuscitation are recommended among all neonates with hydrops fetalis. Treatment is usually based on the underlying etiology.

Historical Perspective

Hydrops fetalis was first discovered by Dr. John William Ballantyne, a Scottish physician and obstetrician, in 1892.

Classification

Hydrops Fetalis may be classified into two groups based on the presence or absence of rhesus iso-immunization:

  • Immune Hydrops Fetalis
  • Non-Immune Hydrops Fetalis (NIHF)

Pathophysiology

It is thought that hydrops fetalis is caused by conditions with either increased rate of fluid transudation from the vascular compartment or decreased lymphatic return to the circulation.

Causes

Hydrops Fetalis is caused by either immune or non-immune conditions.

Differential Diagnosis

Epidemiology and Demographics

Risk Factors

Maternal risk factors in the development of non-immune hydrops fetalis (NIHF) include:[9]

Screening

  • According to the U.S. Preventive Services Task Force (USPSTF), screening for Rh(D) incompatibility by Rh(D) blood typing and antibody testing are strongly recommended for all pregnant women during their first visit for pregnancy-related care.
  • The USPSTF recommends repeated Rh(D) antibody testing for all unsensitized Rh(D)-negative women at 24 to 28 weeks gestation, unless the biological father is known to be Rh(D) negative.[10]

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

There are no established criteria for the diagnosis of hydrops fetalis.

History and Symptoms

The hallmark of hydrops fetalis is an abnormal accumulation of fluid within the fetal body compartments. History and symptoms may differ among patients based on the etiology.

  • A positive history of Rh(D) incompatibility is suggestive of immune hydrops fetalis.

Physical Examination

The physical examination findings in the neonatal period may indicate the underlying diseases.

Laboratory Findings

Electrocardiogram

Ultrasound

An ultrasound showing a fetus with hydrops fetalis
An ultrasound showing a fetus with cystic hygroma and hydrops fetalis. Arrows pointing to bilateral pleural effusion

Echocardiography

Genetic Testing

Other Diagnostic Studies

Treatment

Detailed evaluation and resuscitation are recommended among all neonates with hydrops fetalis. Treatment is usually based on the underlying etiology.[1]

Prevention


Template:WikiDoc Sources

References


  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Vanaparthy R, Mahdy H. PMID 33085361 Check |pmid= value (help). Missing or empty |title= (help)
  2. Kontomanolis EN, Fasoulakis Z (2018). "Hydrops Fetalis and THE Parvovirus B-19". Curr Pediatr Rev. 14 (4): 239–252. doi:10.2174/1573396314666180820154340. PMID 30124157.
  3. Moise KJ (July 2005). "Red blood cell alloimmunization in pregnancy". Semin Hematol. 42 (3): 169–78. doi:10.1053/j.seminhematol.2005.04.007. PMID 16041667.
  4. Gilja BK, Shah VP (1988). "Hydrops fetalis due to ABO incompatibility". Clin Pediatr (Phila). 27 (4): 210–2. doi:10.1177/000992288802700408. PMID 3349731.
  5. Bellini C, Donarini G, Paladini D, Calevo MG, Bellini T, Ramenghi LA, Hennekam RC (May 2015). "Etiology of non-immune hydrops fetalis: An update". Am J Med Genet A. 167A (5): 1082–8. doi:10.1002/ajmg.a.36988. PMID 25712632.
  6. Bellini C, Hennekam RC (March 2012). "Non-immune hydrops fetalis: a short review of etiology and pathophysiology". Am J Med Genet A. 158A (3): 597–605. doi:10.1002/ajmg.a.34438. PMID 22302731.
  7. Hobson SR, Wallace EM, Chan YF, Edwards AG, Teoh MWT, Khaw AP (2020). "Mirroring preeclampsia: the molecular basis of Ballantyne syndrome". J Matern Fetal Neonatal Med. 33 (5): 768–773. doi:10.1080/14767058.2018.1500550. PMID 30614331.
  8. Meng, Dahua; Li, Qifei; Hu, Xuehua; Wang, Lifang; Tan, Shuyin; Su, Jiasun; Zhang, Yue; Sun, Weijia; Chen, Biyan; He, Sheng; Lin, Fei; Xie, Bobo; Chen, Shaoke; Agrawal, Pankaj B.; Luo, Shiyu; Fu, Chunyun (2019). "Etiology and Outcome of non-immune Hydrops Fetalis in Southern China: report of 1004 cases". Scientific Reports. 9 (1). doi:10.1038/s41598-019-47050-6. ISSN 2045-2322.
  9. 9.0 9.1 9.2 Steurer MA, Peyvandi S, Baer RJ, MacKenzie T, Li BC, Norton ME, Jelliffe-Pawlowski LL, Moon-Grady AJ (August 2017). "Epidemiology of Live Born Infants with Nonimmune Hydrops Fetalis-Insights from a Population-Based Dataset". J Pediatr. 187: 182–188.e3. doi:10.1016/j.jpeds.2017.04.025. PMID 28533037.
  10. An X, Wang J, Zhuang X, Dai J, Lu C, Li X; et al. (2015). "Clinical Features of Neonates with Hydrops Fetalis". Am J Perinatol. 32 (13): 1231–9. doi:10.1055/s-0035-1552934. PMID 26070120.
  11. He S, Wang L, Pan P, Wei H, Meng D, Du J; et al. (2017). "Etiology and Perinatal Outcome of Nonimmune Hydrops Fetalis in Southern China". AJP Rep. 7 (2): e111–e115. doi:10.1055/s-0037-1603890. PMC 5468117. PMID 28611934.
  12. Nakayama H, Kukita J, Hikino S, Nakano H, Hara T (1999). "Long-term outcome of 51 liveborn neonates with non-immune hydrops fetalis". Acta Paediatr. 88 (1): 24–8. doi:10.1080/08035259950170547. PMID 10090542.
  13. Neu N, Duchon J, Zachariah P (2015) TORCH infections. Clin Perinatol 42 (1):77-103, viii. DOI:10.1016/j.clp.2014.11.001 PMID: 25677998
  14. Yuan SM (2019) Fetal arrhythmias: Surveillance and management. Hellenic J Cardiol 60 (2):72-81. DOI:10.1016/j.hjc.2018.12.003 PMID: 30576831
  15. Naheed ZJ, Strasburger JF, Deal BJ, Benson DW, Gidding SS (1996). "Fetal tachycardia: mechanisms and predictors of hydrops fetalis". J Am Coll Cardiol. 27 (7): 1736–40. doi:10.1016/0735-1097(96)00054-x. PMID 8636562.
  16. Jauniaux E (1997). "Diagnosis and management of early non-immune hydrops fetalis". Prenat Diagn. 17 (13): 1261–8. doi:10.1002/(sici)1097-0223(199712)17:13<1261::aid-pd292>3.0.co;2-c. PMID 9509544.
  17. 18.0 18.1 Mardy AH, Chetty SP, Norton ME, Sparks TN (August 2019). "A system-based approach to the genetic etiologies of non-immune hydrops fetalis". Prenat Diagn. 39 (9): 732–750. doi:10.1002/pd.5479. PMC 6699893 Check |pmc= value (help). PMID 31087399.
  18. Sparks TN, Lianoglou BR, Adami RR, Pluym ID, Holliman K, Duffy J; et al. (2020). "Exome Sequencing for Prenatal Diagnosis in Nonimmune Hydrops Fetalis". N Engl J Med. 383 (18): 1746–1756. doi:10.1056/NEJMoa2023643. PMC 7650529 Check |pmc= value (help). PMID 33027564 Check |pmid= value (help).
  19. Nassr AA, Erfani H, Fisher JE, Ogunleye OK, Espinoza J, Belfort MA; et al. (2018). "Fetal interventional procedures and surgeries: a practical approach". J Perinat Med. 46 (7): 701–715. doi:10.1515/jpm-2017-0015. PMID 28599395.
  20. Fu DG (2015). "Cardiac Arrhythmias: Diagnosis, Symptoms, and Treatments". Cell Biochem Biophys. 73 (2): 291–296. doi:10.1007/s12013-015-0626-4. PMID 25737133.
  21. "Final Recommendation Statement: Rh(D) Incompatibility: Screening | United States Preventive Services Taskforce".