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Postnatal care of hydrops fetalis

INTRODUCTION

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 IgG antibodies. Before the introduction of antenatal Rh(D) 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 alloimmune hemolytic disease of the newborn".)
  • Nonimmune — Nonimmune hydrops fetalis (NHF) results from 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 Rhesus (Rh) alloimmunization in pregnancy" and "Nonimmune hydrops fetalis".)

DIAGNOSIS

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

  • Skin edema
  • Pleural effusion
  • Pericardial effusion
  • Ascites
  • Polyhydramnios

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Last literature review version 18.2: May 2010
This topic last updated: December 28, 2007
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References
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