Nonimmune hydrops fetalis
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Svena Julien, MD
Svena Julien, MD
- Assistant Professor of Gynecology and Obstetrics
- Division of Maternal-Fetal Medicine
- Johns Hopkins University
- Section Editors
- Louise Wilkins-Haug, MD, PhD
Louise Wilkins-Haug, MD, PhD
- Section Editor — Prenatal Diagnosis and Genetics
- Professor of Obstetrics, Gynecology, and Reproductive Biology
- Harvard Medical School
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
- Joseph A Garcia-Prats, MD
Joseph A Garcia-Prats, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
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 .
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 :
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- CLINICAL MANIFESTATIONS
- Fetal findings
- Maternal findings
- - Mirror syndrome
- Course of pregnancy
- POSTDIAGNOSTIC EVALUATION
- General approach
- DISORDERS ASSOCIATED WITH HYDROPS AND ANTEPARTUM MANAGEMENT
- Cardiovascular abnormalities
- - Structural
- - Arrhythmias
- Thoracic and lymphatic abnormalities
- Twin gestation
- Genitourinary malformations
- Gastrointestinal malformations
- Placental and umbilical cord lesions
- Fetal tumors
- Inborn errors of metabolism
- Skeletal dysplasias
- PREGNANCY AND DELIVERY MANAGEMENT
- STILLBORNS AND NEONATES
- RECURRENCE RISK
- SUMMARY AND RECOMMENDATIONS