Module 15: Hydrops

Question 1

What is hydrops?

Answer 1

An abnormal accumulation of serous fluid in at least two body cavities or tissues

Question 2

What is hydrops?

Answer 2

Abnormal accumulation of serous fluid in at least two body cavities or tissues

Question 3

What are 4 examples of hydrops?

Answer 3

• Pleural/pericardial effusion
• Abdominal ascites
• Edema

Question 4

Hydrops is based on which 2 groups of etiologies?

Answer 4

Immune hydrops and non immune hydrops (NIH)

Question 5

Why may you see fluid in the pelvis first?

Answer 5

Because bowel is the easiest to displace

Question 6

What is pseudoascites?

Answer 6

< 2 mm hypoechoic ring might just be the hypoechoic muscular layer of the abdominal wall but be mistaken for ascites

Question 7

What is a pleural effusion?

Answer 7

Fluid in pleural space around the lungs causing pressure on the mediastinum, thoracic vasculature and heart.

Question 8

Anasarca refers to what?

Answer 8

General edema

Question 9

Where is subcutaneous edema generally first seen?

Answer 9

Fetal scalp and face, then abdomen and limbs

Question 10

What is a late sign of hydrops?

Answer 10

Placental edema

Question 11

How does placental edema appear?

Answer 11

“Ground glass” appearance and > 4cm thick

Question 12

How can the etiology of placental edema be determined?

Answer 12

Whole placenta thick = fetal etiology

Part of placenta thick = placenta vascular malformation

Question 13

If the hydrops is due to placenta vascular malformation what should be seen with the placenta?

Answer 13

Only that part of the placenta will look hydropic

Question 14

What is the pattern with immune hydrops?

Answer 14

1. Ascites
2. Edema
3. Pleural and pericardial effusions

Question 15

Immune hydrops is also known as what?

Answer 15

Alloimmune hydrops or erythroblastosis fetalis

Question 16

What is immune hydrops?

Answer 16

When a rhesus sensitized mother has antibodies to fetal red blood cells (maternal Rh = A- or O-) and maternal antibodies attack positive fetal RBC’S (hemolysis)

Question 17

80% of immune hydrops is due to what?

Answer 17

Anti D antibodies

Question 18

Destruction of fetal red blood cells (hemolysis) causes what three things?

Answer 18

• Anemia in the fetus
• Fetal hepatosplenomegaly
• Erythroblastosis fetalis

Question 19

What is erythroblastosis fetalis?

Answer 19

Outpouring of many immature red blood cells that do not support or carry oxygen well

Question 20

What does erythroblastosis cause?

Answer 20

1. Tissue hypoxia (immature cells can’t carry O2 to cells)
2. Hydrops (fluid leaks out of cells)
3. Cardiac failure (heart works too hard)
4. Demise

Question 21

What does MCA(middle cerebral artery) Doppler show?

Answer 21

With severe anemia the velocity increases in the arteries due to decreases viscosity of the blood.

Question 22

Optical density determination(ODD) amnio is performed to assess what?

Answer 22

Bilirubin level in amniotic fluid

Question 23

Non immune hydrops is commonly seen in the 1st and 2nd trimester with what kind of fetuses?

Answer 23

Spontaneously aborted

Question 24

The etiology for non immune hydrops in North America, Europe and SE Asia is what?

Answer 24

NA/EUR:

• Cardiovascular
• Infection
• Chromosomal abnormality

SE Asia:
- Homozygous Thalassemia

Question 25

What is homozygous thalassemia?

Answer 25

Blood disorder not compatible with life (both parents pass on gene resulting in severe anemia).

Question 26

What are the maternal causes of non immune hydrops? (3)

Answer 26

- Severe diabetes mellitus - Severe anemia - TORCH

Question 27

What are the placental causes of non immune hydrops?

Answer 27

- Chorioangioma (shunting) - Venous thrombosis - Cord torsion

Question 28

What are the main fetal causes of non immune hydrops? (7)

Answer 28

- Cardiac (Malformations, arrythmia, output failure- TTTS) - Thorax and neck (compression anomaly) - Urinary (prune belly) - Chromosomal (45XO, Trisomy 13/18/21, triploidy) - Infection (CMV, parvovirus, toxoplasmosis) - Skeletal dysplasia's - Fetal hypokinesis (athrogryposis)

Question 29

Infection, skeletal dysplasias, fetal hypokinesis, and idiopathy are all examples of which type of hydrops?

Answer 29

Non immune hydrops

Question 30

What does FISH stand for?

Answer 30

Fluorescent In Situ Hybridization

Question 31

What is FISH used for?

Answer 31

Technique used to count chromosomes for common aneuploidies (T13, T18, T21) that only takes 24-48 hours

Question 32

What are two examples of antenatal therapy?

Answer 32

Thoracentesis and paracentesis

Question 33

What does hydrops signify in many conditions?

Answer 33

The terminal stage (fetal decompenation)

Question 34

What is the pattern of hydrops with thoracic abnormalities?

Answer 34

Pleural and pericardial effusuions occur first

Question 35

What is hemolysis?

Answer 35

The separation of hemoglobin from the red cells (destruction of RBC's)

Question 36

When a person has the red cell protein called rhesus factor they are called? And when they don't?

Answer 36

Have protein = Rh+ Don't = Rh-

Question 37

What is thoracentesis?

Answer 37

Removing fluid from the fetal chest (possibly to aid in respiration).

Question 38

What is paracentesis?

Answer 38

Removing fluid from the fetal abdomen (may be done to drain ascites)

Question 39

What is the treatment for TTTS? (3)

Answer 39

- Serial amniocentesis for recipient twin - Fetoscopic laser ablation of communicating vessels in the placenta - Cord occlusion with TRAP syndrome to prevent cardiac failure of donor twin