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Hydrops fetalis - All Information

Definition of Hydrops fetalis:

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.

Causes, incidence, and risk factors:

There are two types of hydrops fetalis. The exact cause depends on which form a baby has.

Immune hydrops fetalis is a complication of a severe form of Rh incompatibility. Rh compatibility causes massive red blood cell destruction, which leads to several problems, including total body swelling. Severe swelling can interfere with how the body organs work.
Non-immune hydrops fetalis occurs when a disease or medical condition disrupts the body's ability to manage fluid. There are three main causes for this type: heart or lung problems, severe anemia (thalassemia), and genetic defects, including Turner syndrome.

The rate of immune hydrops fetalis has dropped dramatically since the introduction of a medicine called RhoGAM, used to treat mothers at risk for Rh incompatibility.

Symptoms:

Symptoms depend on the severity of the condition. Mild forms may cause:

Liver swelling
Pallor

More severe forms may cause:

Breathing problems
Bruising or purplish bruise-like spots on the skin
Heart failure
Severe anemia
Severe jaundice
Total body swelling

Signs and tests:

An ultrasound done during pregnancy may show:

High amounts of amniotic fluid
Abnormally large placenta
Fluid that leads to swelling in the unborn baby's belly area and organs, including the liver, spleen, heart, or lung area

An amniocentesis and frequent ultrasounds will be done to determine the severity of the condition.

Treatment:

Treatment depends on the cause. During pregnancy, treatment may include:

Medicine to cause early labor and delivery of the baby
Early cesarean delivery if condition gets worse
Intrauterine fetal transfusion

Treatment for a newborn may include:

Direct transfusion of packed red blood cells (compatible with the infant's blood type) and an exchange transfusion to rid the baby's body of the substances that are destroying the red blood cells
Needle aspiration to remove extra fluid from around the lungs and belly area
Medicines to control congestive heart failure and help the kidneys remove extra fluids
Methods to help the baby breath, such as a breathing machine

Expectations (prognosis):

Hydrops fetalis often results in death of the infant shortly before or after delivery. The risk is highest among the most premature babies and those who are severely ill at birth.

Complications:

A form of central nervous system damage called kernicterus may occur.

Prevention:

Rh incompatibility, which can lead to this condition, can be prevented if the mother takes a medicine called RhoGAM at certain times during and after pregnancy.

Hydrops fetalis

Reviewed last on: 10/11/2007
Deirdre O’Reilly, MD, MPH, Neonatologist, Division of Newborn Medicine, Children’s Hospital Boston and Instructor in Pediatrics, Harvard Medical School, Boston, Massachusetts. Review Provided by VeriMed Healthcare Network.

References

Abrams ME, Meredith KS, Kinnard P, Clark RH. Hydrops fetalis: a retrospective review of cases reported to a large national database and identification of risk factors associated with death. Pediatrics. 2007 Jul;120(1):84-9.

Kumar V, Abbas AK, Fausto N. Robbins and Cotran Pathologic Basis of Disease. 7th ed. St. Louis, Mo: WB Saunders; 2005.

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