Fetal hydrops Flashcards
1
Q
Fetal hydrops - overview
A
- Definition = abnormal accumulation of serous fluid in two or more fetal compartments (may be pleural or pericardial effusions, ascites, skin oedema, polyhydramnios or placental oedema. 1:2000 births
- Mechanism for development of hydrops = imbalance of interstitial fluid production and inadequate lymphatic return. Can result from congestive heart failure, obstructed lymphatic flow or decreased plasma oncotic pressure
- Causes = non-immune and immune
- Immune hydrops = results from blood group incompatibility between mother and fetus causing fetal anaemia
- Non-immune hydrops = from other causes, including fetal anaemia due to other causes (e.g. infection)
2
Q
Non-immune fetal hydrops - causes
A
- Severe anaemia (congenital parvovirus B19 infection, alpha thalassemia major, massive fetomaternal haemorrhage)
- Cardiac abnormalities (structure abnormalities, fetal tachyarrhythmia, congenital heart block)
- Chromosomal abnormalities (trisomies 13, 18 and 21, Turner’s syndrome)
- Other infections (toxoplasmosis, rubella, CMV, varicella)
- TTTS (recipient twin)
3
Q
Non-immune hydrops - mx
A
- Depends on underlying cause. If tx not possible, option of TOP should be discussed. If in 3rd trimester, delivery may be a better alternative than in utero tx
- Fetal anaemia - in utero blood transfusion
- Pleural effusion - in utero percutaneous drainage and subsequent insertion of shunt into amniotic fluid may be possible
- TTTS - laser photocoagulation of placental anastomoses
- Cardiac - tachyarrhythmias may be treated with maternal digoxin and flecainide; valvotomy of stenotic cardiac valves technically possible, but usually too late if hydrops has already developed
