Module 15: Hydrops Flashcards
What is hydrops?
An abnormal accumulation of serous fluid in at least two body cavities or tissues
What is hydrops?
Abnormal accumulation of serous fluid in at least two body cavities or tissues
What are 4 examples of hydrops?
- Pleural/pericardial effusion
- Abdominal ascites
- Edema
Hydrops is based on which 2 groups of etiologies?
Immune hydrops and non immune hydrops (NIH)
Why may you see fluid in the pelvis first?
Because bowel is the easiest to displace
What is pseudoascites?
< 2 mm hypoechoic ring might just be the hypoechoic muscular layer of the abdominal wall but be mistaken for ascites
What is a pleural effusion?
Fluid in pleural space around the lungs causing pressure on the mediastinum, thoracic vasculature and heart.
Anasarca refers to what?
General edema
Where is subcutaneous edema generally first seen?
Fetal scalp and face, then abdomen and limbs
What is a late sign of hydrops?
Placental edema
How does placental edema appear?
“Ground glass” appearance and > 4cm thick
How can the etiology of placental edema be determined?
Whole placenta thick = fetal etiology
Part of placenta thick = placenta vascular malformation
If the hydrops is due to placenta vascular malformation what should be seen with the placenta?
Only that part of the placenta will look hydropic
What is the pattern with immune hydrops?
- Ascites
- Edema
- Pleural and pericardial effusions
Immune hydrops is also known as what?
Alloimmune hydrops or erythroblastosis fetalis
What is immune hydrops?
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)
80% of immune hydrops is due to what?
Anti D antibodies
Destruction of fetal red blood cells (hemolysis) causes what three things?
- Anemia in the fetus
- Fetal hepatosplenomegaly
- Erythroblastosis fetalis
What is erythroblastosis fetalis?
Outpouring of many immature red blood cells that do not support or carry oxygen well
What does erythroblastosis cause?
- Tissue hypoxia (immature cells can’t carry O2 to cells)
- Hydrops (fluid leaks out of cells)
- Cardiac failure (heart works too hard)
- Demise
What does MCA(middle cerebral artery) Doppler show?
With severe anemia the velocity increases in the arteries due to decreases viscosity of the blood.
Optical density determination(ODD) amnio is performed to assess what?
Bilirubin level in amniotic fluid
Non immune hydrops is commonly seen in the 1st and 2nd trimester with what kind of fetuses?
Spontaneously aborted
The etiology for non immune hydrops in North America, Europe and SE Asia is what?
NA/EUR:
- Cardiovascular
- Infection
- Chromosomal abnormality
SE Asia:
- Homozygous Thalassemia
What is homozygous thalassemia?
Blood disorder not compatible with life (both parents pass on gene resulting in severe anemia).
What are the maternal causes of non immune hydrops? (3)
- Severe diabetes mellitus
- Severe anemia
- TORCH
What are the placental causes of non immune hydrops?
- Chorioangioma (shunting)
- Venous thrombosis
- Cord torsion
What are the main fetal causes of non immune hydrops? (7)
- 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)
Infection, skeletal dysplasias, fetal hypokinesis, and idiopathy are all examples of which type of hydrops?
Non immune hydrops
What does FISH stand for?
Fluorescent In Situ Hybridization
What is FISH used for?
Technique used to count chromosomes for common aneuploidies (T13, T18, T21) that only takes 24-48 hours
What are two examples of antenatal therapy?
Thoracentesis and paracentesis
What does hydrops signify in many conditions?
The terminal stage (fetal decompenation)
What is the pattern of hydrops with thoracic abnormalities?
Pleural and pericardial effusuions occur first
What is hemolysis?
The separation of hemoglobin from the red cells (destruction of RBC’s)
When a person has the red cell protein called rhesus factor they are called? And when they don’t?
Have protein = Rh+
Don’t = Rh-
What is thoracentesis?
Removing fluid from the fetal chest (possibly to aid in respiration).
What is paracentesis?
Removing fluid from the fetal abdomen (may be done to drain ascites)
What is the treatment for TTTS? (3)
- 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
