Paediatrics: Hydrops foetalis

2021-03-09 12:00 AM

Abnormal accumulation of fluid in skin and body compartments. Results from the rate of production of interstitial fluid exceeding absorption.

Hydrops foetalis

Abnormal accumulation of fluid in skin and body compartments. Results from the rate of production of interstitial fluid exceeding absorption.

Characterized in the foetus by:

  • Gross generalized oedema;
  • Ascites;
  • Pleural ± pericardial effusions.

If still present at birth, it results in severe illness. Incidence 71/2500 to 1/4000 births.

Causes

Hydrops is due to underlying disease, singularly or in combination resulting in: rise capillary hydrostatic pressure; fall colloid osmotic pressure; lymphatic obstruction; capillary leaking.

Associated complications

  • Intrauterine/perinatal death.
  • Obstetric complications, e.g. shoulder dystocia.
  • Preterm labour.
  • Pulmonary hypoplasia (pleural effusions).
  • Perinatal asphyxia.

Management

Disorders treatable antenatally

  • Intrauterine blood transfusion (IUT) for haemolytic disease/ parvovirus infection
  • Anti-arrhythmia drugs to treat foetal SVT
  • Laser ablation of foetal vessels (twin-twin transfusion syndrome)

Birth planning

Before birth organize experts help

  • If anaemia likely, have available fresh CMV –ve, O –ve blood, irradiated (if previous IUT), cross-matched blood against the mother
  • Prepare for full resuscitation, ventilation, UVC insertion, paracentesis (ascites), or pleural effusion drainage

Neonatal management

Resuscitation:

  • ventilation, intubation
  • paracentesis, thoracentesis
  • blood transfusion or partial exchange transfusion

Supportive management:

  • cardiac support—pressors, inotropes
  • respiratory support—mechanical ventilation
  • chest tube placement, drainage of ascites
  • fluid and electrolyte management
  • treatment of anaemia: blood transfusion or partial exchange
  • transfusion
  • treatment of infections
  • octreotide to treat chylothorax and ascites

Prognosis

For foetuses or infants with non-immune hydrops, the survival rates are variable, in the range of 50%. Higher survival is reported in infants with SVT, chylothorax, and parvovirus infections, and lower rates in those with chromosomal abnormalities. Survival rates with immune hydrops are> 80%. The neurodevelopmental outcome depends on the cause.