Hydrops Fetalis: How Dangerous is it? Can the Baby be Saved?

Hydrops fetalis is a fetal condition characterized by swelling of the whole body and accumulation of fluid in all the parts of the body. It is usually diagnosed with ultrasound before the birth of a child.

In most cases, it is observed in rhesus-conflict pregnancy and hemolytic disease of the newborn. The prevalence of this condition is 1 case per 1000-14000 births. There are 2 types of hydrops fetalis: immune and nonimmune.

Hydrops Fetalis Types

Immune hydrops: is a severe form of hemolytic disease of the fetus. Currently, it is a rare form due to a timely diagnosis and treatment.

Non-immune hydrops: is considered the outcome of some severe intrauterine diseases (heart defects, hereditary and chromosomal diseases, congenital infections). The reason is difficult to establish, the forecast is unfavorable: in most cases, it ends lethal (deadly).

Symptoms of Hydrops Fetalis

• Swelling of the whole body.
• The accumulation of fluid in all cavities of the body (especially in the abdominal and pleural (a slot-like space between the thin membranes covering the lung), as well as in the cavities of the brain, the heart).
• Anemia.
• Hepatomegaly (enlargement of the liver).
• Splenomegaly (enlargement of the spleen).
• Pale skin.
• Disturbance of breathing (frequent, superficial, may be absent).

Causes

The main cause of the development of immune hydrops fetalis is a hemolytic disease.

The reason that led to the development of nonimmune hydrops often remains unrecognized, but the following factors stand out:

• Chromosomal pathology of the fetus (Down’s syndrome, mosaicism, trisomy, Turner syndrome and others)
• Gene diseases: deficiency of glucose-6-phosphate dehydrogenase, A-thalassemia, Noonan syndrome, achondrogenesis, tanatophoric dwarfism, multiple pterygium syndrome, achondroplasia
• Malformations of the thoracic cavity (dysplasia of the chest, diaphragmatic hernia, cystic adenomatous lung disease)
• Malformations of the urinary system (congenital nephrotic syndrome, urethral and renal defects)
• Cardiovascular pathology (cardiomyopathy, congenital heart defects, anatomical defects, arterial-venous shunts)
• Chorioangioma of the placenta
• With multiple pregnancy (feto-fetal transfusion, acardial twins)
• Infectious diseases of the mother during pregnancy (cytomegalovirus infection, syphilis, parvovirus infection, toxoplasmosis, viral pancarditis Coxsackie)
• Complications of pregnancy (pre-eclampsia, severe anemia, unregistered diabetes, hypoproteinemia)
• Congenital metabolic disorders (type 4 mucopolysaccharidosis, Gaucher’s disease, neuraminidase deficiency, Morquio disease)
• Congenital tumors of the brain and spinal cord, urinary system and digestive tract, liver, sacrococcygeal teratoma, neuroblastoma

Complications and Consequences

• Respiratory failure
• Cardiovascular failure (reduction of the effective contractile function of the heart, leading to violations of intracardiac and pulmonary circulation and cardiac overload)
• Lethal (fatal) outcome (in most cases)

Diagnostics

Diagnosis of hydrops fetalis is aimed at establishing the reason that caused it. First of all, the blood group and Rh factor are determined to confirm/exclude Rhesus-conflict and immune hydrops fetalis.

An analysis of the mother’s life history is carried out: the transferred infectious diseases, surgical interventions, chronic diseases, etc.

Analysis of obstetric-gynecological history: transferred gynecological diseases, features of the course and outcomes of previous pregnancies, etc.

Analysis of the course of the current pregnancy: the total weight gain for pregnancy, the condition during pregnancy, whether it was accompanied by complications (toxicosis, gestosis, threat of miscarriage), etc.

During Ultrasound of the Fetus the Following is Detected

• Swelling of the placenta (child’s place);\
• Polyhydramnios (excess amniotic fluid) in most cases
• Increase in the size of the fetus due to edema (especially increasing the size of the abdomen relative to the size of the head)
• Accumulation of fluid in all cavities of the fetus
• Swelling of subcutaneous fat (a layer under the skin, represented mainly by fat tissue)

A blood test of the fetus and the mother for the blood group and Rh factor for determining the shape of dropsy is also carried out.

Hydrops Fetalis Treatment

With an Immune Hydrops:

• Intrauterine transfusion to the fetus of the Rh-negative blood of the corresponding group (as in the mother)
• Before delivery equipment for cardiopulmonary resuscitation is being prepared
• Immediately after birth, resuscitation and pericardiocentesis are performed (a procedure consisting in piercing a pericardial sac and removing accumulated fluid from it)
• Removal of fluid from all the cavities of the body, where it accumulated, with the help of needles and catheters (tubules)

With Nonimmune Hydrops:

• Even before birth, the equipment for cardiopulmonary resuscitation is being prepared
• Immediately after birth, resuscitation and pericardiocentesis are performed (a procedure consisting in piercing a pericardial sac and removing accumulated fluid from it)
• Removal of fluid from all the cavities of the body, where it was accumulated, with the help of needles and catheters

Hydrops Fetalis Prevention

Prophylaxis is possible only from the side of a pregnant woman.

Pregnancy planning and timely preparation for it (detection and treatment of gynecological and chronic diseases before pregnancy).

Timely registration of the pregnant woman in the maternity welfare center (before 12 weeks of pregnancy).

A regular visit to an obstetrician-gynecologist (once a month in the 1st trimester, once in 2-3 weeks in the 2nd trimester, and once in 7-10 days in the 3rd trimester).

With an Immune Hydrops

The introduction of immunoglobulin into the mother’s body (a special protein that participates in the body’s immune response) prevents the mother’s body from producing antibodies that destroy the red blood cells of the fetus. It is carried out during pregnancy after the detection of Rh-conflict.

With Nonimmune Hydrops

Since the cause is very rarely found, there is no specific prevention.

Prognosis

The prognosis for nonimmune hydrops fetalis is unfavorable and the percentage of surviving children is 20-33%. With the development of hydrops in the first trimester, pregnancy usually ends in spontaneous abortion, in the second and third trimesters the risk of antenatal fetal death is high.

With immune hydrops, the prognosis is more comforting, the effect of prenatal and postnatal treatment reaches 80-90%.