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Postnatal care of hydrops fetalis

Michael E Speer, MD
Section Editor
Leonard E Weisman, MD
Deputy Editor
Melanie S Kim, MD


Hydrops fetalis is a condition of excess fluid accumulation in the fetus that results in significant fetal demise and neonatal mortality. It was first described by Ballantyne in a case series of 65 human fetuses and newborn infants, in which he suggested there were a variety of etiologies [1]. In 1943, Potter defined two forms of hydrops fetalis based upon etiology [2]:

Immune-mediated − In immune-mediated cases, hydrops fetalis is a result of severe fetal anemia due to destruction of fetal red blood cells by maternal immunoglobulin G (IgG) antibodies. Before the introduction of antenatal Rh(D) (rhesus D antigen) immune globulin prophylaxis in the 1960s, the most frequent cause of hydrops fetalis was Rh incompatibility between the mother and fetus. (See "Postnatal diagnosis and management of hemolytic disease of the fetus and newborn".)

Nonimmune − Nonimmune hydrops fetalis (NHF) is associated with numerous disorders that include cardiac, pulmonary, infectious, and genetic etiologies (table 1). NHF accounts for almost 90 percent of current hydropic cases in neonates.

The postnatal care of hydrops fetalis will be reviewed here. The antenatal care of Rhesus alloimmunization and nonimmune hydrops fetalis is discussed separately. (See "Management of pregnancy complicated by Rhesus (D) alloimmunization" and "Nonimmune hydrops fetalis".)


The diagnosis of hydrops fetalis is based upon antenatal ultrasonography or postnatal evaluation that demonstrates two or more of the following findings:

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Literature review current through: Nov 2017. | This topic last updated: Aug 02, 2016.
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