M15: Hydrops Flashcards
define hydrops
abnormal accumulation of serous fluid in at least 2 body cavities or 1 cavity w/ edema
it is the terminal stage for many conditions and signifies fetal decomposition
2 etiologies of hydrops
immune
non-immune
… hydrops is common, but specific etiology that causes hydrops is rare
on hydrops occurs, what is its rate of progression
rapid…. demise can occur w/in 24-48 hours
US appearance of hydrops
ascites pleural effusion pericardial effusion subcutaneous edema placental edema A-V doppler abnormalities low BPP score
why can ascites often be seen in the pelvis first
ascites can cause what pathology in the scrotum
most dependant part of the abdo cavity
hydrocele
describe pseudoascites
what can help us determine if its fluid
< 2 mm hypo ring that might be the hypo muscular layer of the abdominal wall
change probe angle and assess if its sitting in the most dependant location
what can pleural effusion cause
why
upper body edema
polyhydramnios
pulmonary hypoplasia
due to increased pressure on the mediastinum, thoracic vasculature and heart
where is subcutaneous edema usually first seen
what is anasarca
fetal scalp and face….. then abdo and limbs
general edema
what type of edema is a late sign of hydrops
placental edema
US appearance of placental edema
ground glass appearance and > 4 cm thick
whole placenta is thick: if hydrops is of fetal etiology
focal placental thickening: due to placental vascular malformation
pattern of immune hydrops
1st acites
2nd edema
3rd pleural and pericardial effusions
w/ thoracic abnormalities, where is hydrops seen first
what other abnormalities will this cause
seen as pleural and pericardial effusions
chylothorax and heart abnormalities
other names for immune hydrops
alloimmune hydrops
erythroblastosis fetalis
when does immune hydrops occur
when a rhesus mother has antibodies to fetal RBCs
maternal Rh - e.g. A- , or, O-
what is hemolysis
when would it occur
destruction of RBCs… (separation of hemoglobin from the RBCs, the hemoglobin would then be found in the plasma)
with a rhesus mother…. when maternal immunoglobulin antibodies cross the placenta and attack the antigen positive fetal RBCs
People who lack the Rh- lack what on their RBCs
They lack the RBC protein called rhesus factor
What % of immune hydrops is due to D antibodies
80%
What does the destruction of fetal RBCs cause
Anemia in the fetus - due to below normal level of erythrocytes
Fetal hepatosplenomagaly
Erythroblastosis fetalis
What is Erythroblastosis fetalis
Outpouring of many immature RBCs…. the immature RBCs don’t support of carry 02 well to tissue
What does Erythroblastosis fetalis cause
Tissue hypoxia
Hydrops
Cardiac failure
Demise
…. when the immature RBCs cant carry 02 to the tissue, fluid leaks out of cells causing hydrops… this leaking fluid doesn’t return to the heart so it has to work harder to compensate which causes the cardiac failure and demise
Steps to assessing immune hydrops
- Maternal antibody titers by blood test
- detailed fetal Us looking for hydrops
- MCA doppler… w/ severe anemia the velocity increases in the arteries due to decreased velocity of blood
- optical density determination (ODD) amnio is performed to assess bilirubin levels in amniotic fluid
Is MCA doppler reproducible and accurate
Yes
Treatment of immune hydrops
Fetal blood sampling and blood transfusions in utero (PUBS)
What % of hydropic fetuses will survive W/ intraventricular transfusions
Non-hydropic
70-85% of hydropic
85-95% of non-hydrops
