Asim Iqbal, MD

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Asim Iqbal
Dept. Obstetrics & Gynecology
Nishtar Hospital, Multan, Pakistan.



 Presence of excess extra-cellular fluid in two or more sites without any identifiable circulating antibody to red cell antigens



 Generalized skin thickening of more than 5mm and / or two or more of the following
 • Pericardial Effusion
 • Pleural Effusion
 • Ascites 
 • Placental Enlargement 



 Hydrocele can be an early manifestation in hydrops



 Placenta of Hydropic Pregnancy
 Placenta of Normal Pregnancy



 Soft Tissue shadow and pleural effusion in hydropic neonate



   5 - 8 per 10,000
 This data represents the figure of live born hydropic neonates admitted in neonatology units. Actual incidence is much higher, since majority die either in-utero or the pregnancies are terminated electively.



 • It is an end result of an array of disorders of the fetus, umbilical cord and placenta that leads to deranged fluid homeostasis.
 • A wide range of fetal organs are involved - No common mechanism is responsible for the signs of hydrops.



 Three main hypothesis:
 • Anemia 
 • Cardiac Failure 
 • Reduction in Osmotic Pressure (Hypoproteinaemia)



 Fetal Anemia:
 • High output cardiac failure
 • Increase in umbilical venous pressure 
 • Portal hypertension in severely effected fetuses due to increase in hepatic erythropoetic tissue
• Hypoxia and acidosis predispose to epithelial damage in capillaries that ...



 Fetal Anemia:
 • Alpha (α) Thalasaemia
 • Secondary to Feto-maternal Hemorrhage
 • Twin-twin transfusion
 • Other Hemoglobinopathies



 Cardiac Failure:
 • Commonest Mechanism
 • Increase in Cardiac Size 
 • Increased Fetal Venous Pressure 



 Cardiac Failure:
 Disorders of cardiac function / Structure include
 • Cardiomyopathies
 • Tachyarythmias
 • Bradycardias (congenital heart block)
 • Obstructive left heart disease
 • Ebstien's anomaly
 • Atrial isomerism



 Reduced Osmotic pressure:
 Hypoproteiaemia with Subsequent Reduction in Osmotic Pressure
 • Anemia Along With Destruction of Hepatic Architecture
 • Congenital Nephrosis
 Hypoproteiaemia may be the result of loss of proteins from circulation, rather than the cause.



    • Congenital cystic adenomatoid malformation of lung
 •


    • Cystic hygroma
    • Karyotypic abnormalities (45XO)



Fetal Infections:
 • TORCH
 • Parvo Virus B19



 • Polyhydramnios
 • Pre-mature labour
 • Oligohydramnios
 • Problems with third stage
 In an attempt to compensate for the fetal hypoxia, placenta increases in size and sometimes also penetrate deeper into the myometrium. Thus causes the morbid adherence of placenta and can cause the problems for third stage of labor necessitating the manual removal of Placenta.



 • Detailed Ultrasound Scan
 • Fetal Echocardiography
 • Doppler Blood Flow Studies
 • Liquor Volume Assessment (AFI)
 • Placental Thickness & Echogenicity



 • Full Blood Counts
 • Karyotype 
 • Blood Gas Analysis
 • Virology screening
 • Bio-chemical Evaluation
 • Umbilical Venous Pressure



 Blood Can be Obtained From Various Sites
 • Placental Insertion of Umbilical Cord
 • Fetal Insertion of Umbilical Cord
 • Intra-hepatic Vein
 • Heart
 Procedure related fetal loss is 25% in hydropic fetus



•  Multi-disciplinary 
•  Option of Termination of pregnancy 
•  Postmortem examination, Photographs & X-rays 
•  Therapy should only be commenced in the light of a firm diagnosis 
•  Ideal to wait until fetal karyotype is available


 
Prenatal Therapy 
• Transplacental drug therapy 
• Direct fetal drug therapy 
• Invasive procedures


 
Drugs are given to the mother and are passed to the fetus through the placenta 
• The main conditions which respond to this approach are fetal dysrrhythmias (SVT) 
• Once the type of dysrrhythmia is identified, antiarrhythmic agent is given to the mother, with careful monitoring of her ECG & blood levels.


Digoxin, Verapamil, Amiadarone, Flecanide. 
Careful Maternal & Fetal Monitoring is Essential


 
Maternal administration of drugs may be ineffective due to: 
• Maternal Metabolism 
• Maternal Side Effects 
• Variable Passage Across Placenta  


 
• Intraperitoneal 
• Intramuscular 
• Intravascular


 
Blood / Albumen Transfusion to Fetus 
• Intraperitoneal 
• Intravenous 
• Umbilical Vein 
• Hepatic Vein


Articles

 Generalized skin thickening of more than 5mm and / or two or more of the following 
• Pericardial Effusion 
• Pleural Effusion 
• Ascites  
• Placental Enlargement 

Author | Asim Iqbal, MD

Articles

Non-immune Hydrops Fetalis

Scleroderma & Pregnancy