In the management of nonimmune hydrops, measurement of fetal mca psv can help identify the subgroup with fetal anaemia. Types of hydrops pleural effusion there are two types of fetal hydrops. Nonimmune hydrops can also be unrelated to anemia, for example if a fetal tumor or congenital cystic adenomatoid malformation increases the demand for blood flow. Accounts for a minority 10% of cases in presentday pregnancies 8, although historically accounted for a larger proportion of cases in the early to mid 20 th century. Other conditions causing low blood count in the fetus including fetal bleeding hemorrhage, problems with fetal blood cell production and genetic disorders that cause the blood cells to be more easily destroyed. In our case, the parents were unaware of their carrier status for thalassemia until hydrops fetalis was diagnosed at the 20 th week of gestation. Reviewing applications can be fun and only takes a few minutes. Nonimmune hydrops fetalis nihf refers to hydrops in the absence of maternal circulating redcell antibodies, and constitutes up to 90% of all described hydrops fetalis cases.
Rh compatibility causes massive red blood cell destruction, which leads to. The goal of this guideline is to propose a standardized approach to the investigation and management of nonimmune fetal hydrops with a focus on the rare treatable or potentially recurring causes. Hydrops fetalis is defined as accumulation of fluid in serous cavities and or edema of soft tissues in the fetus. It occurs when another condition or disease interferes with the babys ability to regulate fluid. Despite extensive investigations, the etiology of non immune fetal hydrops may remain unknown in 15% to 25% of patients 1, 6, 18. This clinical practice guideline prepared by the authors, and approved by the society of obstetricians and. Nonimmune hydrops fetalis can be caused by a wide variety of factors. Hydrops fetalis is found in about 1 per 2,000 births and is categorized as immune or nonimmune hydrops. Full text get a printable copy pdf file of the complete article 1. Nonimmune hydrops occurs when a disease or medical condition disrupts the bodys ability to manage the fluid. Evaluation of hydrops begins with an antibody screen indirect coombs test to verify that it is non immune, detailed sonography of the fetuses and placenta, including echocardiography and assessment for fetal arrhythmia, and middle cerebral artery doppler evaluation for anemia, as well as fetal karyotype andor. Nonimmune hydrops fetalis is now the most common type of hydrops fetalis. Hydrops is due to several factors leading to accumulation of edema. We save fresh and frozen liver, skin, and bile for biochemical studies, if needed.
Pdf nonimmune hydrops fetalis nihf is a rare fetal condition with a very high mortality in spite of advances in prenatal diagnostic. Hydrops is classified according to its cause as immune or non immune. The advent of rho d immune globulin resulted in a decline in the incidence of isoimmune fetal hydrops and increasing prominence of nonimmune causes of this. The rate of dizygotic twins is increased by certain hereditary and environmental factors. Non immune fetal hydrops is a clinical phenotype and not a diagnosis. Investigation and management of nonimmune fetal hydrops. Nonimmune hydrops is the presence of two or more abnormal fetal fluid collections in the absence of red cell alloimmunization. Just a few of the many known causes of hydrops include. Evaluation of hydrops begins with an antibody screen indirect coombs test to verify that it is nonimmune, detailed sonography of the fetuses and placenta, including echocardiography and assessment for fetal arrhythmia, and middle cerebral artery doppler evaluation for anemia, as well as fetal karyotype andor. About half of unborn babies with hydrops fetalis do not survive. This anemia can have either an immune or nonimmune cause.
Treatments for newborns may include blood transfusions, drainage of fluid from the chest and abdomen to help breathing, neonatal intensive care, medications. The risk is even higher for babies who are ill at birth or born very early. The identification of hydrops by ultrasound is very frustrating to the family and physicians because it requires extensive search for the etiology, which include a wide variety of diseases and pathologies. This is a condition in which mother who has rh negative blood type makes antibodies to her babys rh positive blood cells, and the antibodies cross the. In 1943 potter 1 differentiated non immune hydrops nih from immune hydrops due to fetalmaternal blood incompatibilities. The causes of nonimmune hydrops are so numerous that treatment depends on the specific problem that is causing hydrops. Removing extra fluid from around the lungs and abdominal organs with a needle. Hydrops fetalis refers to abnormal fluid collections in fetal soft tissues and serous cavities. Hydrops fetalis usually stems from fetal anemia, when the heart needs to pump a much greater volume of blood to deliver the same amount of oxygen. The nonimmune form of hydrops fetalis has many causes including. Figure 1 antenatal ultrasound ndings suggestive of fetal hydrops. Appropriate investigation and management of non immune fetal hydrops education of readers about the causes of non immune fetal hydrops and its prenatal counselling and management provision of a standardized approach to non immune fetal hydrops, emphasizing the search for prenatally treatable conditions and recurrent genetic etiologies. In the management of non immune hydrops, measurement of fetal mca psv can help identify the subgroup with fetal anaemia.
Sep 19, 2019 hydrops fetalis caused by alphathalassemia. See letter diagnosis and management of non immune hydrops in the newborn in volume 71 on page f148. Nonimmune fetal hydrops is a condition easily diagnosed by antenatal ultrasound. It occurs when abnormal amounts of fluid build up in two or more body areas of a fetus or newborn. The condition is subdivided in to a immune hydrops. Since the incorporation of rhimmune globulin into antepartum care for rhnegative women, 90% of hydropic cases are nonimmune in origin 2 definition. Parvovirus parvovirus is the commonest infectious etiology for hydrops foetalis. Over 50% of twins are currently the result of infertility treatment 5. Non immune hydrops is the presence of two or more abnormal fetal fluid collections in the absence of red cell alloimmunization. See letter diagnosis and management of non immune hydrops in the newborn in volume 71 on page f149. A list of the more common causes is shown in table 1. Get a printable copy pdf file of the complete article 753k, or click on a page image below to browse page by page. Immune hydrops fetalis ihf was initially recognized as the combination of neonatal hydrops, anemia, and jaundice along with erythroblastosis and red blood cell hemolysis by diamond and coinvestigators in 1932. Stepwise investigation of nonimmune fetal hydrops fetal imaging 1detailed morphology obstetrical ultrasound in a tertiary care centre look for site and severity of hydrops.
Non immune hydrops fetalis caused by herpes simplex virus type 2 in the setting of recurrent maternal infection. Feb 05, 2014 hydrops fetalis it is defined as generalized fetal edema or anasarca, which can be detected by an antenatal usg. Nonimmune hydrops fetalis is a heterogeneous disorder, caused by a large number of underlying pathologic processes. This is a condition in which mother who has rh negative blood type makes antibodies to her babys rh positive blood cells, and the antibodies cross the placenta. Virus responsible for non immune hydrops foetalis is. Diagnosis and management of nonimmune hydrops in the newborn. Nonimmune hydrops fetalis yurdakok journal of pediatric. Rh incompatibility causes massive red blood cell destruction. Up to 90% of all cases of hydrops today are nonimmune hydrops. These guidelines educate readers about the causes of nonimmune fetal hydrops and its prenatal counselling and management. Prenatal diagnosis of cystic hygroma can be made within 2nd trimester of pregnancy. All other causes are described as non immune hydrops fetalis nihf.
Nonimmune hydrops fetalis is a serious fetal condition in which abnormal fluid accumulates in at least two different fetal compartments, and in which circulating antibodies against redcell antigens are absent in the mother. Various structural abnormalities in the fetus may subsequently lead to hydrops and hence require follow up scan in all cases. See commentary diagnosis of nonimmune hydrops in the newborn. Hydrops fetalis is accumulation of extracellular fluid in fetal body cavities. The diagnosis is reached when there is fluid accumulation in more than one extravascular space, this includes soft tissue edema in the skin or scalp, or fluid in body cavities such as ascites pleural effusion, pericardial effusion, or hydrocele. Two types of hydrops immune hydrops is the complication of severe form of rhesus rh incompatibility. The type depends on the cause of the abnormal fluid. See the article diagnosis and management of nonimmune hydrops in the newborn. With the marked decrease in this condition due to prophylaxis with immune globulin, most cases of hydrops fetalis are now caused by other conditions and are known as non immune hydrops. As a result, nihf now accounts for almost 90 percent of cases of hydrops4, with the prevalence in published series reported as 1 in 17003000 pregnancies.
The woman went into preterm labor at 31 weeks of gestation. The main differential diagnosis is hydrops fetalis see this term without alphathalassemia, which is a common non specific sign of numerous fetal or maternal disorders. Idiopathic hydrops fetalis may represent about half of all cases of hydrops fetalis of nonimmunologic origin i. Pdf non immune hydrops fetalis nihf is a rare fetal condition with a very high mortality in spite of advances in prenatal diagnostic techniques. However, nonimmune hydrops fetalis cases have been more frequently reported. Non immune hydrops fetalis nihf refers to hydrops in the absence of maternal circulating redcell antibodies, and constitutes up to 90% of all described hydrops fetalis cases. Rh incompatibility causes a large number of red blood cells in the. See commentary diagnosis of non immune hydrops in the newborn. Non immune hydrops foetalis obstetrics mcq pg blazer. Other genetic disorders predisposing to nihf include other congenital anemias, such as erythropoietic porphyria e.
You will also have access to many other tools and opportunities designed for those who have languagerelated jobs or are passionate about them. Ballantyne first described hydrops fetalis in, although this condition had been recognized. Hydrops fetalis it is defined as generalized fetal edema or anasarca, which can be detected by an antenatal usg. Hydrops fetalis is excessive extravasation of fluid into the third space in a fetus which could be due to heart failure, volume overload, decreased oncotic pressure, or increased vascular permeability. Nonimmune hydrops fetalis caused by herpes simplex virus type 2 in the setting of recurrent maternal infection. Since the incorporation of rh immune globulin into antepartum care for rhnegative women, 90% of hydropic cases are non immune in origin 2. This post has been voted on by the steemstem curation team and voting. Hydrops is a very serious condition that causes fetal death in about half of all cases. Immune hydrops fetalis is a complication of a severe form of rh incompatibility. Immune hydrops fetalis is no longer very common due to advances in the prevention of hemolytic disease of the newborn. Links to pubmed are also available for selected references.
Immune hydrops fetalis is most often a complication of a severe form of rh incompatibility, which can be prevented. The rest of this section deals only with nonimmune hydrops fetalis. Automatic update in this post has been voted on by the steemstem curation team and voting trail. Immune hydrops accounts for 1020%of cases maternal antibodies against redcells of the fetus cross the placenta and coat fetal red cells which are then destroyed hemolysis in the fetal spleen. By comparison, hydrops allantois or hydrops amnion is an accumulation of excessive fluid in the allantoic or amniotic space, respectively. Non immune hydrops can be the symptom of a number of congenital conditions. Login or register free and only takes a few minutes to participate in this question. Mar, 2014 valerie desilets, francois audibert, investigation and management of nonimmune fetal hydrops, j obstet gynaecol can 20. Aug 22, 2019 the non immune form of hydrops fetalis has many causes including. Magann hydrops fetalis hf is defined as the presence of excessive fetal fluid in two or more of the following spaces. There are three main causes for nonimmune hydrops, which include the heart or lung. With the development and widespread use of rhd immune globulin, the prevalence of rhd alloimmunization and associated hydrops has dramatically decreased. The current classification of immune and nonimmune hydrops foetalis is not sufficient to describe the complex pathophysiology leading to heart failure and.
Appropriate investigation and management of nonimmune fetal hydrops education of readers about the causes of nonimmune fetal hydrops and its prenatal counselling and management provision of a standardized approach to nonimmune fetal hydrops, emphasizing the search for prenatally treatable conditions and recurrent genetic etiologies. Peer comments on this answer and responses from the answerer agree. Hydrops was diagnosed more frequently while the fetus was alive, before 20 weeks gestation, and associated with chromosome anomaly than found previously. The other viruses implicated include cytomegalovirus, hepatitis b virus, herpes simplex virus, rubella virus and adenovirus. Hydrops fetalis have a poor prognosis since this condition frequently leads to the infants death shortly after or before delivery. Hydrops fetalis is a condition in the fetus characterized by an accumulation of fluid, or edema, in at least two fetal compartments. Hydrops fetalis survival rate, prognosis, pictures, causes. There is more to steemstem than just writing posts, check here for some more tips on being a community inmjne. Onethird of hydropic fetuses are discovered incidentally during prenatal sonography in the first or second trimester of gestation. A systembased approach to the genetic etiologies of nonimmune hydrops fetalis. Occasionally, there is no treatment and the baby must be delivered. Aetiology, diagnosis and treatment of hydrops foetalis. Sep 08, 2019 removing extra fluid from around the lungs and abdominal organs with a needle. Rh incompatibility causes a large number of red blood cells in the fetus to be destroyed this is also known as hemolytic disease of the newborn.
Nonimmune hydrops can also be unrelated to anemia, for example if a fetal tumor or congenital cystic adenomatoid malformation increases the demand. Full text get a printable copy pdf file of the complete article 200k, or click on a page image below to browse page by page. The subject of this study was 38 cases of non immune hydrops fetalis and 11 cases of fetal hydrothorax and or ascites fha, a syndrome characterized by the accumulation of pleural effusion and. Hydrops fetalis, or hydrops, is a condition that occurs when large amounts of fluid build up in a babys tissues and organs causing extreme swelling. To improve our services and products, we use cookies own or third parties authorized to show advertising related to client preferences through the analyses of navigation customer behavior. Nonimmune hydrops, the most common type, is caused by a fetal medical condition or birth defect that affects the bodys ability to manage fluid. Examples of conditions that can interfere with the babys fluid management include. Hidrosp anemic fetuses, including those with rh disease and alpha thalassemia major, can be treated with blood transfusions while still in the womb.
Hydrops fetalis genetic and rare diseases information. Jan 25, 2012 hydrops fetalis is a serious condition in which abnormal amounts of fluid build up in two or more body areas of a fetus or newborn. Fortunately, this condition is rare, occurring in only one out of every 1,000 pregnancies. This post has been voted on by the steemstem curation team and. All other causes are described as nonimmune hydrops fetalis nihf. In 1943 potter 1 differentiated nonimmune hydrops nih from immune hydrops due to fetalmaternal blood incompatibilities. Hydrops fetalis is a serious condition in which abnormal amounts of fluid build up in two or more body areas of a fetus or newborn. Hydrops is a symptom of a wide range of conditions which have resulted in an imbalance in fetal fluid between the vascular and interstitial space.
Nonimmune hydrops fetalis nihf comprises the subgroup of cases not caused by red cell alloimmunization eg, rhd, kell. A systembased approach to the genetic etiologies of non immune hydrops fetalis. Hydrops fetalis is excessive extravasation of fluid into the third space in a fetus which could be due to heart failure, volume overload, decreased oncotic pressure. Non immune hydrops fetalis occurs in approximately one of every 1,000 births. Health care resources for this disease expert centres diagnostic tests patient organisations 44 orphan drug s 6.
Cystic hygroma associated with nonimmune fetal hydrops. December pages you can also join our discord here to get to know the rest of the community. It may be manifestation of a variety of underlying disorders. Non immune hydrops is universal edema unassociated with erythroblastosis. Twin rates in the united states have increased from 18. Pdf nonimmune hydrops fetalis nihf is a rare fetal condition with a very high mortality in spite of advances in prenatal diagnostic techniques. Nonimmune hydrops can be the symptom of a number of congenital conditions. Incidence of fetal hydrops is approximately 1 in 2500 to 3500 neonates with incidence coexistence of hydrops and cystic hygroma even rarer. There are two types of hydrops fetalis, immune and nonimmune.