What Is Hydrops Fetalis?

Fetal edema (hydrops foetalis) refers to the excessive accumulation of extracellular fluid in the fetus. It is a disease with a high mortality due to a variety of fetal, placental, and maternal diseases. The currently widely used standards are: excessive extracellular fluid in two or more parts of the body, including skin edema (5mm), placental thickening (> 6cm), or excessive amniotic fluid. The incidence rate is 1/3700 1/2500. Despite the continuous improvement of diagnosis and treatment technology, the mortality of perinatal infants due to fetal edema is as high as 82% -93%. Therefore, early diagnosis and treatment will help reduce the serious complications that may occur in the third trimester of pregnancy, reduce the trauma and mental stress caused by the induction of labor in late pregnancy, and reduce the perinatal mortality.

Basic Information

nickname

Fetal edema

English name

Hydrops Fetalis

Visiting department

obstetrics

Common causes

Rh / ABO blood group incompatibility, cardiovascular malformations, chromosomal abnormalities, intrauterine infections, twin blood transfusion syndrome, and severe anemia, etc .; some are unknown

Common symptoms

Abnormal accumulation of serous fluid in two or more fetal chambers such as skin, pleura, pericardium, placenta, peritoneum, and amniotic fluid

Causes of Fetal Edema

The etiology of fetal edema can be divided into two categories: immune and non-immune.

Immune edema

Mainly due to maternal and infant Rh / ABO blood group incompatibility, the same family immune response, fetal hemolytic anemia, and finally fetal edema. Caused by other homologous immunizations such as C and E antigens or other blood group systems such as Kell and Fy antigens are more common.

The pathological mechanisms of fetal edema include capillary leakage caused by ischemia due to severe anemia, portal and umbilical vein hypertension caused by hepatic parenchymal dysfunction caused by extramedullary hematopoiesis, and hypoproteinemia caused by liver dysfunction. The colloid osmotic pressure is reduced.

2. Non-immune edema

The causes of non-immune fetal edema are complex, including cardiovascular malformations, chromosomal abnormalities, intrauterine infections, twin blood transfusion syndrome, and severe anemia, which cause fetal heart failure or intrauterine distress, and continue to activate the renin-angiotensin system. Cause fetal edema. In addition, the cause of fetal edema is still unknown in 44%.

(1) Abnormal placenta.

(2) Fetal lung malformations.

(3) Cardiovascular malformations and abnormal cardiac function.

(4) Blood causes, such as thalassemia.

(5) Fetal chromosomal abnormalities.

(6) Infection with bacterial viruses in the womb, such as parvovirus, streptococcus, spirochaete, cytomegalovirus, coxsackie virus, toxoplasma, etc.

Fetal Edema Examination

Regular pregnancy tests, B-ultrasound, deformity screening, and fetal chromosome tests for pregnant women with high risk factors can also be performed for blood group antibody screening, blood tests for children, chromosome tests, and virus tests.

Fetal Edema Diagnosis

When prenatal examination finds that there is too much amniotic fluid, fetal edema should be considered first. Routine B ultrasound examination should be performed: the thickness of the fetal skin is> 5mm; ascites, pleural effusion, and pericardial effusion;

Differential diagnosis of fetal edema

It should be distinguished from the following symptoms:

Fetal distress

Fetal distress is a condition in which the fetus has signs of hypoxia and endangers the health and life of the fetus.

2. Fetal asphyxia

Intrauterine asphyxia is when the fetus has insufficient oxygen or other gases in the womb, or has trouble with the respiratory system, and has difficulty breathing or even stops breathing.

Fetal Edema Treatment Principles

Prenatal evaluation

Assess fetal condition, maturity, etiology, and whether prenatal treatment is effective and whether the fetus can survive.

2. Prenatal treatment

(1) Fetal arrhythmia, such as supraventricular tachycardia, anti-arrhythmic drugs can be given to the mother, the fetus uses ECG to monitor the correction of arrhythmia.

(2) Fetal edema caused by severe anemia, red blood cells can be injected through the abdominal cavity or umbilical vein under the guidance of B ultrasound. Intraperitoneal blood is often taken up incompletely, and hemoglobin is broken down into bilirubin. The fetus may require phototherapy or even blood exchange treatment after birth.

(3) Prenatal fetal surgery to correct malformations, such as congenital pulmonary cystic adenoma-like malformations, isolated lungs, and zygomatic tail teratoma. Others, such as diaphragmatic hernia, can also be considered for prenatal surgery.

(4) Non-specific treatment: such as amniocentesis to withdraw an appropriate amount of amniotic fluid to reduce preterm labor.