In the name of God

Hydrops Fetalis

Hydrops = Generalized subcutaneous edema in the fetus or neonate

Definition : Excess serous fluid in at least one space (ascites, pleural effusion, or pericardial effusion) + skin edema (> 5 mm thick) Excess fluid in two spaces without edema

Hydrops Fetalis Immune Hydrops Fetalis (10%) Non Immune Hydrops Fetalis (90%)

Pathogenesis Anemia Cardiac failure Fetal Hypoxemia

Pathogenesis (cont). Extra vascular protein leakage → increased capillary permeability → hypoalbuminemia → Accumulation of fluid in body cavities Placental perfusion abnormalities

Etiology Hematologic: Due to anemia (10% of cases) : Isoimmune hemolytic disease (RH incompatibility). Hemozygous alphathalassemia Hemozygous G6PD d, Feto maternal hemorrhage - twin - to twin transfusion Bone marrow failure - bone marrow replacement - leukemia

In RH incompatibility : Fetus is RH + / mother is RH – Maternal exposure to foreign antigens → IgG antibodies fetal antigens → destruction of fetal RBCs → Hemolysis hydrops fetal anemia → reticulocytosis (Hb<7 g/dL) → erythroblastosis. Against In severe form In moderate form In severe form

Cardiovascular: Due to heart failure (20% cases) Rhythm disturbances Major cardiac disease

Renal (5% of cases) Nephrosis, RVT, urinary obstruction

Infection (8% of cases) TORCH-Syphilis-Congenital Hepatitis, Parvovirus….

Pulmonary (5% of cases) Chylothorax, diaphragmatic hernia , intrathoracic mass

Placental or cord (rare)

Maternal conditions (5% of cases) : Toxemia, diabetes, thyrotoxicosis

Gastrointestinal (5% of cases) : Meconium peritonitis …..

Chromosomal (5% of cases) : Turner syndrome, trisomy 13,18,21

Miscellaneous (10% of cases) : Cystic hygroma, wilms’ tumor – teratoma - Neuroblastom

Unknown (20% of cases) :

Signs of hydrops : Pericardial & pleural effusions Ascites Skin edema Hepatosplenomegaly Polyhydramnios Placental thickening

Diagnosis : Pregnant woman with : Polyhydramnios, severe anemia, toxemia, isoimmune disease → ultrasonic examination → Fluid accumulation in the fetus or placenta of circulating maternal antibody → NIHF In the absence

Post natal Evaluation