Hydrops

Question 1

Definition

Answer 1

Excessive fluid accumulation in 2 or more fetal compartments of the following:
pleural effusion
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Ascites
Polyhydramnios
Pericardial effusion

Question 2

Causes of hydrops

Answer 2

CAUSTIC mneumonic
10% immune 90% non immune
Chromosomal
Anaemia
Unexplained
Structural
Twins
Infection
Cardiac

Question 3

Pathophysiology of hydrops

Answer 3

Dysregulation of the net fluid movement between the vascular and interstitial spaces by the following 4 mechanisms

1. Obstruction to lymphatic drainage in the thoracic and abdominal cavities (congenital anomaly, neoplasm)
2. Increased capillary permeability (infection)
3. Increased central venous pressure (high output cardiac failure, obstructed venous return to the heart)
4. Decreased osmotic pressure (hypoproteinameia - due to liver congestion (heart failure), damage/stress (infection)

Question 4

Things to ID in hx about hydrops

Answer 4

Antenatal: antibodies, aneuploidy screen, invasive testing, morphology scan, anti D
Obs hx: ?rh isoimmunisation - then all details about that birth
Recent viral infection
Recent trauma
Ethnicity, consanguinity and fam hx (alpha that, G6PD)
?SLE or sjogrens (anti Ro/La and heart block
Profession - ?childcare worker/risk of infections

Question 5

Examination in hydrops - mirror syndrome signs

Answer 5

Temp, bp, oxygen sats

cardio resp: pulmonary and peripheral orders, hyper reflex is, clonus

Question 6

Investigations for hydrops

Answer 6

Bloods: group and antibody screen, kleiauer, pet (mirror), FBE, HbE, DNA studies, partner testing, g6PD, TORCH, anti Ro and la if Bradyarrythmia, TFTs and TSHrAB if tachyarrythmia

CTG
USS: structural anomalies, echo, mca PSV, growth, compartments affected
Amnio - PCR for infections, microarray

Question 7

Management

Answer 7

MDT: paeds, MFM, genetics
Counselling: offer TOP/ continuation - guarded prognosis
Steroids if indicated
Treat cause
Fetal surveillance
Delivery - consider IOL so can time delivery, tertiary Centre, may need c/s depending on degree of hydrops

Question 8

Neonatal management

Answer 8

Resus, intubation, ventilation
May need paracentesis/pleural effusion drainage/ pericardial effusion drainage
Albumin, diuretics, transfusion
Dx workup
Treat cause if identified

Question 9

Prognosis

Answer 9

50% mortality if born with hydrops
Lowest mortality it’s isolate chylothorax
Bout 100% die if cardiac anomaly

Question 10

3 primary mechanisms associated with hydrops

Answer 10

Intrauterine anaemia
Intrauterine heart failure
Hypoproteinemia