Fetal Hydrops Flashcards

1
Q

Diagnosis

A
  • At least 2 of the following criteria on ultrasound
    o Subcutaneous oedema (>5mm fluid beneath skin)
    o Ascites
    o Pleural effusion
    o Pericardial effusion
  • Often associated with polyhydramnios and thickened placenta
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2
Q

Causes

A

-10% due to isoimmunisation
- 90% non immune

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3
Q

Specific causes

A

Pneumonic: CAUSTIC:
1. Cardiac:
- Arrythmias: SVT/Heart Block (Anti Ro/LA pos)
- High output cardiac failure: Sacrococcygeal teratoma, placental tumour, haemangioma
- Structural abnormality: Hypoplastic left heart, cardiomyopathy, coarctation of the aorta
2. Anaemia
- Fetomaternal Haemorrhage
- Rhesus/Other isoimmunisation
- Parvovirus
-G6PD
- Alpah Thal (Barts Hydrops)
3. Unexplained
4. Structural
- Thoracic abnormality: CCAM, chylothorax, diaphragmatic hernia
- Skeletal dysplasia
5. Twins
- TTTS
6. Infection
- Parvovirus
- STORCH: Syphilis, Toxoplasma, Rubella, CMV, Herpes
- Other: Listeria, Coxsackie, Varicella
7. Chromosomal/Congenital
- Aneuploidy: XO, Trisomies 13, 18, 21, Noonan syndrome
- Congenital nephrotic syndrome, inherited disorders of metabolism

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4
Q

Clinical Assessment

A
  • History
    o Pregnancy complications ie bleeding
    o Aneuploidy testing
    o Blood group/Anti-D
    o Morphology result
    o Recent viral illness, possible exposures (ie childcare worker)
    o Ethnicity – ie risk of G6PD, alpha thalassaemia
  • Examination
    o Presence of rash, fever
    o BMI, Urinalysiso Fundal height
    o Fetal Doppler auscultation +/- bedside ultrasound
  • Investigations
    o Bloods
  • FBE (microcytic anaemia suggestive of thalassaemia)
  • Group and antibody screen
  • Kleihauer
  • G6PD/thalassaemia screening
  • STORCH serology (especially Parvovirus)
  • Anti-Ro, anti-La if suspected heart block
    o CTG
    o Ultrasound
  • Tertiary scan for congenital anomalies and echocardiography
  • Assessment of MCA PSV for fetal anaemia
  • Growth/wellbeing/dopplers
    o Offer amniocentesis
  • PCR for infections
  • Karyotype
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5
Q

Management

A
  • Immediate referral to MFM unit
  • Celestone if 24-34/40
  • Termination can be offered if very pre-viable or severe abnormality identified
  • Treat underlying cause
    o Anaemia
  • Fetal blood sampling and intrauterine transfusion
    o Arrhythmia
  • SVT – digoxin, sotalol, flecainide, amiodarone
  • Bradycardia/heart block – salbutamol
    o Thoracic malformations
  • Thoracentesis or shunt for pleural effusions
    o Syphilis
  • Penicillin
  • Observe for ‘mirror syndrome’
    o Development of oedema, hypertension, proteinuria in the mother
  • Counselling
    o Prognosis depends on cause
    o If no cause identified: mortality 50%
    o If untreatable cause identified, termination should be offered
  • Hydrops with structural cardiac anomaly has 100% mortality
    o Recurrence uncommon unless due to isoimmunisation or inherited disorder
  • Delivery
    o If fetus stable, delivery at 37/40 in tertiary centre reasonable
    o CS for obstetric indications (ascitic tap prior to IOL if large AC)
    o Cord blood for serology, Coombe’s, FBE
    o Paediatricians in attendance (likely to need early intubation, diuretic, pleural tap, paracentesis)
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