1. In the name of God

2. Hydrops Fetalis

3. Hydrops = Generalized subcutaneous edema in the fetus or neonate

4. 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

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

6. Pathogenesis
Anemia
Cardiac failure
Fetal Hypoxemia

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

8. 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

9. 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

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

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

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

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

14. Placental or cord (rare)

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

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

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

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

19. Unknown (20% of cases) :

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

25. 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

32. Post natal Evaluation