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Nonimmune hydrops fetalis

Charles J Lockwood, MD, MHCM
Svena Julien, MD
Section Editors
Louise Wilkins-Haug, MD, PhD
Deborah Levine, MD
Joseph A Garcia-Prats, MD
Deputy Editor
Vanessa A Barss, MD, FACOG


Hydrops fetalis refers to abnormal fluid collections in fetal soft tissues and serous cavities. Nonimmune hydrops fetalis (NIHF) comprises the subgroup of cases not caused by red cell alloimmunization (eg, Rh(D), Kell).


The prevalence of NIHF ranges from 1/1500 to 1/4000 births [1-6]. Wide variations in reported prevalence are due to differences in definitions, populations, thoroughness of evaluation, and whether late pregnancy terminations were included.

The widespread use of Rh(D) immune globulin has dramatically decreased the prevalence of Rh(D) alloimmunization and associated hydrops. As a result, NIHF now accounts for almost 90 percent of hydrops cases [1].


The pathogenesis of NIHF is incompletely understood. Fluid homeostasis within the vascular and interstitial compartments is controlled by both hydrostatic and osmotic pressures as demonstrated by the Starling equation. Cellular mechanisms also regulate fluid movement and contribute to the Starling forces. Dysregulation of the net fluid movement between the vascular and interstitial spaces leading to NIHF can be caused by fetal disorders with one or more of the following features [7]:

Obstructed lymphatic drainage in the thoracic and abdominal cavities

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Literature review current through: Nov 2017. | This topic last updated: Aug 04, 2017.
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