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{{CMG}} {{AE}} {{Adnan Ezici}}  
{{CMG}} {{AE}} {{Adnan Ezici}}  
==Overview==
==Overview==
Hydrops Fetalis indicates an excessive accumulation of interstitial fluid in [[extravascular]] [[compartments]] and body cavities which is characterized by generalized skin [[edema]], [[ascites]], [[pleura]]l, or [[pericardial effusion]], and [[placenta]]l 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]], [[polyhydramnious]], or [[prematurity]] are associated with a particularly poor [[prognosis]] among patients.
Hydrops Fetalis indicates an excessive accumulation of interstitial fluid in extravascular [[compartments]] and body cavities which is characterized by generalized skin [[edema]], [[ascites]], [[pleura]]l, or [[pericardial effusion]], and [[placenta]]l 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 for gestational age|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 [[placenta]]l thickness (indicative of [[placenta]]l edema), [[polyhydramnios]], [[ascites]], [[pleural effusion]], and [[pericardial effusion]]. Detailed evaluation and [[resuscitation]] are recommended among all [[neonate]]s with hydrops fetalis. Treatment is usually based on the underlying [[etiology]].
[[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 [[placenta]]l thickness (indicative of [[placenta]]l edema), [[polyhydramnios]], [[ascites]], [[pleural effusion]], and [[pericardial effusion]].


==Historical Perspective==
==Historical Perspective==
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*Preexisting maternal [[diabetes]]  
*Preexisting maternal [[diabetes]]  
*[[Mental illness]]
*[[Mental illness]]
*[[Illicit drug use]]  
*[[drug abuse|Illicit drug use]]  
*[[Preeclampsia]]
*[[Preeclampsia]]


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**The cause of deaths after the [[neonatal]] period are usually underlying disease rather than hydrops fetalis itself.
**The cause of deaths after the [[neonatal]] period are usually underlying disease rather than hydrops fetalis itself.
**[[Gestational age]] is predictive of [[mortality]], as [[preterm]] [[infants]] with this condition are more likely to die.
**[[Gestational age]] is predictive of [[mortality]], as [[preterm]] [[infants]] with this condition are more likely to die.
**The presence of either [[large birth weight]], [[polyhydramnious]], or [[prematurity]] are associated with a particularly poor [[prognosis]] among patients.
**The presence of either [[large for gestational age|large birth weight]], [[polyhydramnios]], or [[prematurity]] are associated with a particularly poor [[prognosis]] among patients.


==Diagnosis==
==Diagnosis==
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===History and Symptoms===
===History and Symptoms===
The hallmark of hydrops fetalis is an abnormal accumulation of fluid within the [[fetal]] body [[compartment]]s. History and symptoms may differ among patients based on the etiology.  
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.  
*A positive history of Rh(D) incompatibility is suggestive of [[immune]] hydrops fetalis.


===Physical Examination===
===Physical Examination===
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===Laboratory Findings===
===Laboratory Findings===
*Hydrops Fetalis may be caused by maternal [[TORCH]] infections, and [[parvovirus B19]] [[infection]], therefore, [[antibodies]] against these infections should be checked.<ref name="pmid33085361">{{cite journal |vauthors=Vanaparthy R, Mahdy H |title= |journal= |volume= |issue= |pages= |date= |pmid=33085361 |doi= |url=}}</ref>
*Hydrops Fetalis may be caused by maternal [[TORCH]] infections, and [[parvovirus B19]] [[infection]], therefore, [[antibodies]] against these infections should be checked.<ref name="pmid33085361">{{cite journal |vauthors=Vanaparthy R, Mahdy H |title= |journal= |volume= |issue= |pages= |date= |pmid=33085361 |doi= |url=}}</ref>
*[[Sjögren syndrome]] may cause hydrops fetalis with [[complete heart block]]s and bradyarrhythmias, therefore, [[Anti-SS-A]]/SS-B antibodies should be considered in suspected cases.
*[[Sjögren syndrome]] may cause hydrops fetalis with [[complete heart block]]s and bradyarrhythmias, therefore, [[Sjögren's syndrome laboratory findings|Anti-SS-A/SS-B antibodies]] should be considered in suspected cases.
*An elevated concentration of [[alpha-fetoprotein]] (AFP) may suggest fetomaternal hemorrhage, which may result in hydrops fetalis.  
*An elevated concentration of [[alpha-fetoprotein]] (AFP) may suggest fetomaternal hemorrhage, which may result in hydrops fetalis.  
*Immune hydrops fetalis can be detected by direct and indirect [[coombs test]].
*Immune hydrops fetalis can be detected by direct and indirect [[coombs test]].
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===Electrocardiogram===
===Electrocardiogram===
*A [[fetal]] [[ECG]] (fECG) may be helpful in the diagnosis of fetal [[arrythmias]]. Fetal ECG may show [[premature contractions]], [[tachyarrhythmias]], and [[bradyarrhythmias]].<ref name="pmid30576831">Yuan SM (2019) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=30576831 Fetal arrhythmias: Surveillance and management.] ''Hellenic J Cardiol'' 60 (2):72-81. [http://dx.doi.org/10.1016/j.hjc.2018.12.003 DOI:10.1016/j.hjc.2018.12.003] PMID: [https://pubmed.gov/30576831 30576831]</ref>
*A [[fetal]] [[ECG]] (fECG) may be helpful in the diagnosis of fetal [[arrythmias]]. Fetal ECG may show [[premature ventricular contraction|premature contractions]], [[tachyarrhythmias]], and [[bradyarrhythmias]].<ref name="pmid30576831">Yuan SM (2019) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=30576831 Fetal arrhythmias: Surveillance and management.] ''Hellenic J Cardiol'' 60 (2):72-81. [http://dx.doi.org/10.1016/j.hjc.2018.12.003 DOI:10.1016/j.hjc.2018.12.003] PMID: [https://pubmed.gov/30576831 30576831]</ref>
*Duration of [[tacyhcardia]] positively correlated with the presence of hydrops fetalis.<ref name="pmid8636562">{{cite journal| author=Naheed ZJ, Strasburger JF, Deal BJ, Benson DW, Gidding SS| title=Fetal tachycardia: mechanisms and predictors of hydrops fetalis. | journal=J Am Coll Cardiol | year= 1996 | volume= 27 | issue= 7 | pages= 1736-40 | pmid=8636562 | doi=10.1016/0735-1097(96)00054-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8636562  }} </ref>
*Duration of [[tachycardia]] positively correlated with the presence of hydrops fetalis.<ref name="pmid8636562">{{cite journal| author=Naheed ZJ, Strasburger JF, Deal BJ, Benson DW, Gidding SS| title=Fetal tachycardia: mechanisms and predictors of hydrops fetalis. | journal=J Am Coll Cardiol | year= 1996 | volume= 27 | issue= 7 | pages= 1736-40 | pmid=8636562 | doi=10.1016/0735-1097(96)00054-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8636562  }} </ref>


===Ultrasound===  
===Ultrasound===  
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===Genetic Testing===
===Genetic Testing===
*[[Genetic tests]] for non-immune hydrops fetalis include [[karyotype analysis]], which may demonstrate [[aneuploidy]], and [[chromosomal microarray analysis]] (CMA) which may further demonstrate [[copy number variants]] (CNVs), submicroscopic [[deletions]], and [[duplications]] (as small as 50 – 100 kb).<ref name="pmid31087399">{{cite journal |vauthors=Mardy AH, Chetty SP, Norton ME, Sparks TN |title=A system-based approach to the genetic etiologies of non-immune hydrops fetalis |journal=Prenat Diagn |volume=39 |issue=9 |pages=732–750 |date=August 2019 |pmid=31087399 |pmc=6699893 |doi=10.1002/pd.5479 |url=}}</ref>
*[[cytogenetics|Genetic tests]] for non-immune hydrops fetalis include [[karyotype]] analysis, which may demonstrate [[aneuploidy]], and [[DNA Microarray|chromosomal microarray analysis]] (CMA) which may further demonstrate [[gene copy number|copy number variants]] (CNVs), submicroscopic [[deletion|deletions]], and [[gene duplication|duplications]] (as small as 50 – 100 kb).<ref name="pmid31087399">{{cite journal |vauthors=Mardy AH, Chetty SP, Norton ME, Sparks TN |title=A system-based approach to the genetic etiologies of non-immune hydrops fetalis |journal=Prenat Diagn |volume=39 |issue=9 |pages=732–750 |date=August 2019 |pmid=31087399 |pmc=6699893 |doi=10.1002/pd.5479 |url=}}</ref>
*Even after applying these [[genetic tests]], half of the underlying etiology of NIHF remains unclear.
*Even after applying these genetic tests, half of the underlying [[etiology]] of NIHF remains unclear.
*A more detailed and broader genetic test, [[whole exam sequencing]] (WES), may be helpful in the diagnosis of NIHF.<ref name="pmid33027564">{{cite journal| author=Sparks TN, Lianoglou BR, Adami RR, Pluym ID, Holliman K, Duffy J | display-authors=etal| title=Exome Sequencing for Prenatal Diagnosis in Nonimmune Hydrops Fetalis. | journal=N Engl J Med | year= 2020 | volume= 383 | issue= 18 | pages= 1746-1756 | pmid=33027564 | doi=10.1056/NEJMoa2023643 | pmc=7650529 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33027564  }} </ref>  
*A more detailed and broader genetic test, whole exam sequencing (WES), may be helpful in the diagnosis of NIHF.<ref name="pmid33027564">{{cite journal| author=Sparks TN, Lianoglou BR, Adami RR, Pluym ID, Holliman K, Duffy J | display-authors=etal| title=Exome Sequencing for Prenatal Diagnosis in Nonimmune Hydrops Fetalis. | journal=N Engl J Med | year= 2020 | volume= 383 | issue= 18 | pages= 1746-1756 | pmid=33027564 | doi=10.1056/NEJMoa2023643 | pmc=7650529 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33027564  }} </ref>  
**Underlying etiologies of NIHF which can be detected by [[whole exam sequencing]] include RASopathies (disorders of [[RAS–MAPK]] cell-signaling pathway), [[inborn errors of metabolism]], [[musculoskeletal]], [[lymphatic]], [[cardiovascular]], [[neurologic]], [[hematologic]] disorders, and others.
**Underlying etiologies of NIHF which can be detected by whole exam sequencing include RASopathies (disorders of RAS–MAPK cell-signaling pathway), [[inborn errors of metabolism]], [[musculoskeletal]], [[lymphatic]], [[cardiovascular]], [[neurologic]], [[hematologic]] disorders, and others.
**Approximately one-third of NIHF disorders with unclear etiology, [[Whole exam sequencing]] (WES) is shown to detect a possible genetic cause.
**Approximately one-third of NIHF disorders with unclear etiology, whole exam sequencing (WES) is shown to detect a possible genetic cause.


===Other Diagnostic Studies===
===Other Diagnostic Studies===
*Other diagnostic studies for hydrops fetalis include [[chorionic villous sampling]] (CVS), which may demonstrate [[chromosomal abnormalities]] or Hb [[Barts]] disease.<ref name="pmid33085361">{{cite journal |vauthors=Vanaparthy R, Mahdy H |title= |journal= |volume= |issue= |pages= |date= |pmid=33085361 |doi= |url=}}</ref>
*Other diagnostic studies for hydrops fetalis include [[chorionic villus sampling]] (CVS), which may demonstrate [[chromosomal abnormalities]] or Hb [[Barts]] disease.<ref name="pmid33085361">{{cite journal |vauthors=Vanaparthy R, Mahdy H |title= |journal= |volume= |issue= |pages= |date= |pmid=33085361 |doi= |url=}}</ref>


==Treatment==
==Treatment==
The treatment depends on the cause.   
Detailed evaluation and [[resuscitation]] are recommended among all [[neonate]]s with hydrops fetalis. Treatment is usually based on the underlying [[etiology]].<ref name="pmid33085361">{{cite journal |vauthors=Vanaparthy R, Mahdy H |title= |journal= |volume= |issue= |pages= |date= |pmid=33085361 |doi= |url=}}</ref>
*There is no treatment for some of the [[congenital heart diseases|structural heart diseases]] and [[chromosome abnormality|chromosomal abnormalities]]; the mainstay of therapy is supportive care.
*The mainstay of treatment for severe [[anemia]] in [[fetus]] and [[neonate]] are intrauterine transfusion and [[blood transfusion]], respectively.
*Fetal interventional procedures such as [[shunt]] placement, and [[thoracentesis]] may be required among patients with the rapid accumulation of fluid, [[mediastinal]] shift, and [[polyhydramnios]].<ref name="pmid28599395">{{cite journal| author=Nassr AA, Erfani H, Fisher JE, Ogunleye OK, Espinoza J, Belfort MA | display-authors=etal| title=Fetal interventional procedures and surgeries: a practical approach. | journal=J Perinat Med | year= 2018 | volume= 46 | issue= 7 | pages= 701-715 | pmid=28599395 | doi=10.1515/jpm-2017-0015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28599395  }} </ref>
*Neonates with severe [[ascites]], [[pleural effusions]], and [[pericardial effusion]] may be treated with [[paracentesis]],[[thoracentesis]], and [[pericardiocentesis]], respectively.<ref name="pmid33085361">{{cite journal |vauthors=Vanaparthy R, Mahdy H |title= |journal= |volume= |issue= |pages= |date= |pmid=33085361 |doi= |url=}}</ref>
*Treatment with either [[Antiarrhythmic agent|antiaryythmics]], [[defibrillation]]/[[cardioversion]], [[pacemaker|pacemaker implantation]], [[implantable cardiac defibrillator]] (ICD) or [[radiofrequency ablation]] may be warranted for the neonates presenting with [[arrhythmia]].<ref name="pmid25737133">{{cite journal| author=Fu DG| title=Cardiac Arrhythmias: Diagnosis, Symptoms, and Treatments. | journal=Cell Biochem Biophys | year= 2015 | volume= 73 | issue= 2 | pages= 291-296 | pmid=25737133 | doi=10.1007/s12013-015-0626-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25737133 }} </ref>


Severely [[anemic]] fetuses can be treated with [[blood transfusions]] while still in the womb.  
==Prevention==
 
*According to the U.S. Preventive Services Task Force (USPSTF):<ref name="urlFinal Recommendation Statement: Rh(D) Incompatibility: Screening | United States Preventive Services Taskforce">{{cite web |url=https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/rh-d-incompatibility-screening#bootstrap-panel--6 |title=Final Recommendation Statement: Rh(D) Incompatibility: Screening &#124; United States Preventive Services Taskforce |format= |work= |accessdate=}}</ref>
{{Certain conditions originating in the perinatal period}}
**Administration of a full (300µg) dose of Rh (D) [[immunoglobulin]] is recommended for all unsensitized Rh (D)-negative women after repeated antibody testing at 24–28 weeks’ [[gestation]].
 
**If an Rh (D)-positive or weakly Rh (D)-positive (eg, Du-positive) [[infant]] is delivered, a dose of Rh (D) immunoglobulin should be repeated [[postpartum]], preferably within 72 hours after delivery. Administering Rh (D) [[immunoglobulin]] at other intervals after delivery has not been studied.
[[de:Hydrops fetalis]]
**Unless the biological father is known to be Rh (D)-negative, a full dose of Rh (D) [[immunoglobulin]] is recommended for all unsensitized Rh (D)-negative women after [[amniocentesis]] and after induced or [[spontaneous abortion]]; however, if the pregnancy is less than 13 weeks, a 50 µg dose is sufficient.
[[pl:Obrzęk uogólniony płodu]]
**The benefit of routine administration of Rh (D) immunoglobulin after other [[obstetric]] procedures or complications such as [[chorionic villus sampling]], [[ectopic pregnancy]] termination, [[cordocentesis]], fetal surgery or manipulation (including [[external cephalic version|external version]]), [[antepartum haemorrhage|antepartum placental hemorrhage]], [[abdominal]] trauma, [[antepartum]] fetal death, or [[stillbirth]] is uncertain due to inadequate evidence.


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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


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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".