Hydrops fetalis

Background

• Accumulation of edema in at least two fetal compartments
• Usually stems from fetal anemia
• Immune vs Non-Immune

Clinical Features

• Occurs during gestation, may be maternally asymptomatic or present as spontaneous abortion, or patient (mother) may have sings/symptoms of pathology that caused hydrops
• Fetal/neonatal edema is typically located in:
  • Subcutaneous tissue/scalp
  • Pleura (pleural effusion)
  • Pericardium (pericardial effusion)
  • Abdomen (ascites)

Complications

• Spontaneous abortions
• Poor fetal outcomes

Causes

Immune

• Rh disease
  • RhD-negative mothers during pregnancy and/or within 72 hours of the delivery OR vaginal bleeding
  • Prevention with administration of anti-D IgG (Rho(D) Immune Globulin) injections

Non-Immune

• Iron deficiency anemia
• Parvovirus B19 (Fifth's Disease)
• CMV
• Syphilis

Evaluation

• Ultrasound screening

Management

• OBGYN Consultation/Referral
• Rh Status
• Iron for all pregnant women

Also See

• Erythema Infectiosum (Fifth disease)
• Kawasaki Disease
• Rho(D) Immune Globulin (RhoGAM)

References

• Uptodate
• Bellini C, Hennekam RC. Non-immune hydrops fetalis: a short review of etiology and pathophysiology. Am J Med Genet A 2012; 158A:597.
• Haile-Mariam T, Polis MA: Viral Illnesses, in Marx JA, Hockberger RS, Walls RM, et al (eds): Emergency Medicine: Concepts and Clinical Practice, ed. 7. St. Louis, Mosby, Inc., 2010, (Ch) 128: p.1712.