Hydrops Fetalis

Posted by e-Medical PPT Thursday, July 28, 2011
Hydrops fetalis is a condition in the fetus characterized by an abnormal collection of fluid with at least  two of the following:
Edema (fluid beneath the skin, more than 5 mm).
Ascites(fluid in abdomen)
Pleural effusion(fluid in the pleural cavity, the fluid-filled space that surrounds the lungs)
Pericardial effusion(fluid in the pericardial sac, covering  that surrounds the heart)

Hydrops fetalis is typically diagnosed during ultrasound evaluation for other  complaints such as :
Size greater than dates
Fetal tachycardia
Decreased fetal movement
Abnormal serum screening
Antenatal hemorrhage

Hydrops fetalis is found in about 1 per 2,000 births and is categorized as :
Immune hydrops
Nonimmune hydrops

Immune hydrops
Accounts for 10-20%of cases
Maternal antibodies against red-cells of the fetus cross the placenta and coat fetal red cells which are then destroyed (hemolysis) in the fetal spleen.
The severe anemia leads to
High-output congestive heart failure.
Increased red blood cell production by the spleen and liver leads to hepatic circulatory obstruction (portal hypertension)
Anti-D, anti-E, and antibodies directed against other Rh antigens comprise the majority of antibodies responsible for hemolytic disease of the newborn .
However, there are numerous, less commonly encountered, antibodies such as anti-K (Kell), anti-Fya (Duffy) , and anti-Jka (Kidd)  that may also cause hemolytic disease of the newborn.

Non-immune hydrops
Accounts for 80 -90% of cases
Any other cause besides immune.
In general nonimmune hydrops (NIH) is caused by a failure of the interstitial fluid (the liquid between the cells of the body) to return into the venous system .

This may due to:
Cardiac failure (High output failure from anemia,  sacrococcygeal teratoma, fetal adrenal neuroblastoma, etc.)
Impaired venous return (Metabolic disorders)
Obstruction to normal lymphatic flow (Thoracic malformations)
Increased capillary permeability
Decreased colloidal osmotic pressure (Congential nephrosis)...

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