Non-immune Hydrops Fetalis

Posted by e-Medical PPT Tuesday, July 10, 2012
Non-immune Hydrops Fetalis defined as Presence of excess extra-cellular fluid in two or more sites without any identifiable circulating antibody to red cell antigens.
Generalized skin thickening of  more than 5mm and / or two or more of the following
 Pericardial effusion
 Pleural Effusion
 Ascites
 Placental Enlargement

Pathogenesis
It is an end result of an array of disorders of the fetus, umbilical cord and placenta that leads to deranged fluid homeostasis.
A wide range of fetal organs are involved - No common mechanism is responsible for the signs of hydrops.
Three main hypothesis:
 Anemia
 Cardiac Failure
 Reduction in Osmotic Pressure (Hypoproteinaemia)

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 compartment.

Fetal Anemia may be due to:
Alpha Thalasaemia
Secondary to Feto-maternal Hemorrhage
Twin-twin transfusion
Other Hemoglobinopathies

Cardiac Failure:
Disorders of cardiac function / Structure include
Cardiomyopathies
Tachyarythmias
Bradycardias (Congenital heart block)
Obstructive left heart disease
Ebstien’s anomaly
Atrial isomerism
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