Fetal Hydrops Flashcards
Diagnosis
- 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
Causes
-10% due to isoimmunisation
- 90% non immune
Specific causes
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
Clinical Assessment
- 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
Management
- 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)