Non-Immune Hydrops

Question 1

How do you define NIH?

Answer 1

Fluid accumulation in 2 or more spaces in the fetus without maternal alloimmunization

Question 2

How do you counsel a patient about the finding of NIH in the first trimester?

Answer 2

Maternal and fetal work-up. Poor prognosis; offer termination

Question 3

How do you counsel a patient about the finding of NIH in the second trimester?

Answer 3

Maternal and fetal work-up. Treatment if cause is reversible (I.e. fetal anemia due to parvovirus)

Question 4

How do you counsel a patient about the finding of NIH in the third trimester?

Answer 4

Maternal and fetal work-up. Treatment in the early third trimester with reversible causes. Deliver in the late third trimester.

Question 5

What is the differential diagnosis for NIH?

Answer 5

Cardiac 
Chromosomal 
Infection 
Thalassemia 
Tumor 
TTTS/TAPS
Trauma

Question 6

What work-up do you perform if NIH is identified in the first trimester?

Answer 6

CBC for maternal anemia, MCV 
Type and screen
KB
Infectious work-up 
Cardiac screen 
CVS

Question 7

What work-up do you perform if NIH is identified in the second trimester?

Answer 7

CBC for maternal anemia, MCV 
Type and screen
KB
Infectious work-up 
Detailed anatomic survey 
\+/- MRI 
Echocardiogram
Amniocentesis

Question 8

What work-up do you perform if NIH is identified in the third trimester?

Answer 8

Detailed anatomy
Echocardiogram
Maternal history
If no arrhythmia then MCA Doppler
If no anemia then amnio (get karyotype + CMA + AFAFP + PCR for CMV, toxoplasmosis)
If anemia then amnio or PUBS if IUT is planned then karyotype, PCR for CMV, Parvo, too, MCV of parents, DNA testing for alpha that with low MCV. other considerations include G6PD, pyruvate kinase deficiency, lysosomal enzyme testing if no other etiology

Question 9

What are the most common causes of NIH in the first trimester?

Answer 9

Cardiac 
Chromosomal
Hematologic
Twin complication
Placental abnormalities

Question 10

How do you manage a patient with NIH diagnosed at 12 weeks gestation?

Answer 10

Assess cause and possibility for treatment; otherwise, discuss termination

Question 11

How do you manage a patient with NIH diagnosed at 24 weeks gestation?

Answer 11

Assess for cause. Assess for treatment possibility. Administer betamethasone (shared decision making model); however, discuss significant risk of neonatal demise in the setting of hydrops and prematurity.

Question 12

How do you manage a patient with NIH diagnosed at 32 weeks gestation?

Answer 12

Arrhythmia - administer anti arrhythmic medication
Anemia - IUT
Hydrothorax - needle drainage
CPAM - if macro cystic needle drainage, if microcytic steroids
TTTS/TAPS - laser photocoagulation

Question 13

What is isolated pleural effusion called?

Answer 13

Chylothorax