Exxcellence pearls: Nonimmune hydrops fetalis Flashcards
Define hydrops fetalis.
Excessive fluid in two or more fetal compartments including skin edema, pleural effusion, pericardial effusion, ascites and polyhydramnios
What percentage of hydrops fetalis is nonimmune?
90%
What causes nonimmune fetal hydrops?
Usually due to changes in osmotic pressure due to liver disease, increased capillary permeability, obstruction of venous return, obstruction of lymphatic drainage, volume overload, or direct myocardial injury.
What are early signs of fetal hydrops?
Late signs?
Polyhydramnios and ascites.
Skin or scalp edema.
Define polyhydramnios.
AFI greater than 25 or MVP greater than 8.
What is the differential diagnosis for nonimmune fetal hydrops?
Chromosome anomalies Metabolic storage diseases Cardiovascular anomalies Thoracic abnormalities Anemia Infection G.I. malformations Multiple gestation Other skeletal and neuromuscular anomalies and syndromes
What percentage of nonimmune fetal hydrops is caused by anemia?
Describe the pathogenesis of alpha thalassemia.
25%
Hemorrhage, hemolysis, defective red cell production leads to high output cardiac failure.
What is the most common cause of nonimmune fetal hydrops?
Cardiovascular anomalies account for 40%. Usually due to structural defects, arrhythmias or vascular abnormalities.
What percentage of nonimmune fetal hydrops is caused by infection?
What infectious agents are involved?
8%
TORCH organisms and parvovirus, syphilis, varicella, adenovirus, coxsackie virus
How does twin gestation increase the risk of nonimmune fetal hydrops?
Twin-to-twin transfusion syndrome in monochorionic twins.
What historical features are important for the evaluation of fetal hydrops?
Ethnicity, genetic abnormalities, metabolic diseases, recent exposure to infection.
What testing should be performed in the setting of nonimmune fetal hydrops?
Detailed ultrasound with Doppler MCA to detect anemia
CBC with indices, type and screen, viral serology, Kleihauer-Betke stain, fetal karyotype
