Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-5f56664f6-c65qm Total loading time: 0 Render date: 2025-05-08T04:34:29.148Z Has data issue: false hasContentIssue false

29 - Hydrops fetalis

from Section 4 - Specific conditions associated with fetal and neonatal brain injury

Published online by Cambridge University Press:  12 January 2010

By
David P. Carlton
Edited by
David K. Stevenson ,
William E. Benitz ,
Philip Sunshine ,
Susan R. Hintz  and
Maurice L. Druzin
David K. Stevenson
Affiliation:
Stanford University School of Medicine, California
William E. Benitz
Affiliation:
Stanford University School of Medicine, California
Philip Sunshine
Affiliation:
Stanford University School of Medicine, California
Susan R. Hintz
Affiliation:
Stanford University School of Medicine, California
Maurice L. Druzin
Affiliation:
Stanford University School of Medicine, California
Get access

Summary

Introduction

Hydrops fetalis is the presence of excess body water in the fetus resulting in skin edema coupled with effusions in the pleural, peritoneal, or pericardial space. Because most pregnancies in the United States include routine fetal assessment by ultrasound, most cases of hydrops will be recognized before birth. An associated abnormality can be diagnosed either ante- or postnatally in the majority of patients who have hydrops. The prognosis for survival is generally poor. Over 50% of fetuses diagnosed with hydrops die in utero, and of those that survive to delivery, over half will die postnatally despite aggressive support.

Immune hydrops

Immune hydrops is a late manifestation of the anemia that results from fetal erythrocyte destruction by transplacentally acquired maternal antibodies to fetal red-cell antigens. The severity of anemia necessary to disturb total body water is unpredictable, but a hematocrit of less than 20% is commonly associated with hydrops. Fetuses with an immune basis for their hydrops who are not treated with intrauterine red-cell transfusion face a significant risk of in utero death.

Historically, the most common antigen causing an antibody-mediated hemolytic anemia was the Rh D. Anemia as a function of sensitization to the D antigen is infrequent today because of the routine use of Rh immunoglobulin in the management of women who are Rh-D-negative. Sensitization to other red-cell antigens, including Kell, e, and c also causes fetal hemolytic anemia and results in immune hydrops.

Type
Chapter
Information
Fetal and Neonatal Brain Injury , pp. 325 - 330
Publisher: Cambridge University Press
Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Carlton, DP, McGillivray, BC, Schreiber, MD. Nonimmune hydrops fetalis: a multidisciplinary approach. Clin Perinatol 1989; 16: 839–51.CrossRefGoogle ScholarPubMed
Ismail, KM, Martin, WL, Ghosh, S, et al. Etiology and outcome of hydrops fetalis. J Matern Fetal Med 2001; 10: 175–81.CrossRefGoogle ScholarPubMed
Nicolaides, KH, Soothill, PW, Clewell, WH, et al. Fetal haemoglobin measurement in the assessment of red cell isoimmunisation. Lancet 1988; 1: 1073–5.CrossRefGoogle ScholarPubMed
Adams, MM, Marks, JS, Gustafson, J, et al. Rh hemolytic disease of the newborn: using incidence observations to evaluate the use of Rh immune globulin. Am J Public Health 1981; 71: 1031–5.CrossRefGoogle ScholarPubMed
Clarke, CA, Mollison, PL, Whitfield, AG. Deaths from rhesus haemolytic disease in England and Wales in 1982 and 1983. Br Med J 1985; 291: 17–19.CrossRefGoogle ScholarPubMed
Wenk, RE, Goldstein, P, Felix, JK. Kell alloimmunization, hemolytic disease of the newborn, and perinatal management. Obstet Gynecol 1985; 66: 473–6.Google ScholarPubMed
Maidman, JE, Yeager, C, Anderson, V, et al. Prenatal diagnosis and management of nonimmunologic hydrops fetalis. Obstet Gynecol 1980; 56: 571–6.Google ScholarPubMed
Nakayama, H, Kukita, J, Hikino, S, et al. Long-term outcome of 51 liveborn neonates with non-immune hydrops fetalis. Acta Paediatr 1999; 88: 24–8.CrossRefGoogle ScholarPubMed
Abrams, ME, Meredith, KS, Kinnard, P, et al. Hydrops fetalis: a retrospective review of cases reported to a large national database and identification of risk factors associated with death. Pediatrics 2007; 120: 84–9.CrossRefGoogle ScholarPubMed
Huang, HR, Tsay, PK, Chiang, MC, et al. Prognostic factors and clinical features in liveborn neonates with hydrops fetalis. Am J Perinatol 2007; 24: 33–8.CrossRefGoogle ScholarPubMed
Jones, DC. Non-immune fetal hydrops: diagnosis and obstetrical management. Semin Perinatol 1995; 19: 447–61.CrossRefGoogle ScholarPubMed
Holzgreve, W, Holzgreve, B, Curry, CJ. Non-immune hydrops fetalis: diagnosis and management. Semin Perinatol 1985; 9: 52–67.Google ScholarPubMed
Apkon, M. Pathophysiology of hydrops fetalis. Semin Perinatol 1995; 19: 437–46.CrossRefGoogle ScholarPubMed
Brace, RA. Effects of outflow pressure on fetal lymph flow. Am J Obstet Gynecol 1989; 160: 494–7.CrossRefGoogle ScholarPubMed
Gest, AL, Bair, DK, Vander Straten, MC. The effect of outflow pressure upon thoracic duct lymph flow rate in fetal sheep. Pediatr Res 1992; 32: 585–8.CrossRefGoogle ScholarPubMed
Johnson, P, Sharland, G, Allan, LD, et al. Umbilical venous pressure in non-immune hydrops fetalis: correlation with cardiac size. Am J Obstet Gynecol 1992; 167: 1309–13.CrossRefGoogle ScholarPubMed
Weiner, CP. Umbilical pressure measurement in the evaluation of non-immune hydrops fetalis. Am J Obstet Gynecol 1993; 168: 817–23.CrossRefGoogle Scholar
Phibbs, RH, Johnson, P, Tooley, WH. Cardiorespiratory status of erythroblastotic newborn infants. II. Blood volume, hematocrit, and serum albumin concentration in relation to hydrops fetalis. Pediatrics 1974; 53: 13–23.Google ScholarPubMed
Gest, AL, Hansen, TN, Moise, AA, et al. Atrial tachycardia causes hydrops in fetal lambs. Am J Physiol 1990; 258: H1159–63.Google ScholarPubMed
DeVore, GR, Acherman, RJ, Cabal, , et al. Hypoalbuminemia: the etiology of antenatally diagnosed pericardial effusion in rhesus-hemolytic anemia. Am J Obstet Gynecol 1982; 142: 1056–7.CrossRefGoogle ScholarPubMed
Cormode, EJ, Lyster, DM, Israels, S. Analbuminemia in a neonate. J Pediatr 1975; 86: 862–7.CrossRefGoogle Scholar
Hallman, N, Norio, R, Rapola, J. Congenital nephrotic syndrome. Nephron 1973; 11: 101–10.CrossRefGoogle ScholarPubMed
Moise, AA, Gest, AL, Weickmann, PH, et al. Reduction in plasma protein does not affect body water content in fetal sheep. Pediatr Res 1991; 29: 623–6.CrossRefGoogle Scholar
Hutchison, AA, Drew, JH, Yu, VY, et al. Non-immunologic hydrops fetalis: a review of 61 cases. Obstet Gynecol 1982; 59: 347–52.Google Scholar
Kobori, JA, Urich, H. Intrauterine anoxic brain damage in non-immune hydrops fetalis. Biol Neonate 1986; 49: 311–17.CrossRefGoogle Scholar
Lumbers, ER, Gunn, AJ, Zhang, DY, et al. Non-immune hydrops fetalis and activation of the renin–angiotensin system after asphyxia in preterm fetal sheep. Am J Physiol Regul Integr Comp Physiol 2001; 280: R1045–51.CrossRefGoogle ScholarPubMed
O'Connell, AE, Boyce, AC, Lumbers, ER, et al. The effects of asphyxia on renal function in fetal sheep at midgestation. J Physiol 2003; 552: 933–43.CrossRefGoogle ScholarPubMed
O'Connell, AE, Boyce, AC, Kumarasamy, V, et al. Long-term effects of a midgestational asphyxial episode in the ovine fetus. Anat Rec A Discov Mol Cell Evol Biol 2006; 288: 1112–20.CrossRefGoogle ScholarPubMed
George, S, Gunn, AJ, Westgate, JA, et al. Fetal heart rate variability and brain stem injury after asphyxia in preterm fetal sheep. Am J Physiol Regul Integr Comp Physiol 2004; 287: R925–33.CrossRefGoogle ScholarPubMed
Bose, C. Hydrops fetalis and in utero intracranial hemorrhage. J Pediatr 1978; 93: 1023–4.CrossRefGoogle ScholarPubMed
Stanworth, SJ, Hackett, GA, Williamson, LM. Fetomaternal alloimmune thrombocytopenia presenting antenatally as hydrops fetalis. Prenat Diagn 2001; 21: 423–4.CrossRefGoogle ScholarPubMed
Craze, JL, Salisbury, AJ, Pike, MG. Prenatal stroke associated with maternal parvovirus infection. Dev Med Child Neurol 1996; 38: 84–5.Google ScholarPubMed
Doyle, LW, Kelly, EA, Rickards, AL, et al. Sensorineural outcome at 2 years for survivors of erythroblastosis treated with fetal intravascular transfusions. Obstet Gynecol 1993; 81: 931–5.Google ScholarPubMed
Janssens, HM, Haan, MJ, Kamp, IL, et al. Outcome for children treated with fetal intravascular transfusions because of severe blood group antagonism. J Pediatr 1997; 131: 373–80.CrossRefGoogle ScholarPubMed
Ahmad, FK, Sherman, SJ, Hagglund, KH, et al. Isolated unilateral fetal pleural effusion: the role of sonographic surveillance and in utero therapy. Fetal Diagn Ther 1996; 11: 383–9.CrossRefGoogle ScholarPubMed
Bullard, KM, Harrison, MR. Before the horse is out of the barn: fetal surgery for hydrops. Semin Perinatol 1995; 19: 462–73.CrossRefGoogle ScholarPubMed
Simpson, LL. Fetal supraventricular tachycardias: diagnosis and management. Semin Perinatol 2000; 24: 360–72.CrossRefGoogle ScholarPubMed
Haverkamp, F, Noeker, M, Gerresheim, G, et al. Good prognosis for psychomotor development in survivors with nonimmune hydrops fetalis. BJOG 2000; 107: 282–4.CrossRefGoogle ScholarPubMed
McMahan, MJ, Donovan, EF. The delivery room resuscitation of the hydropic neonate. Semin Perinatol 1995; 19: 474–82.CrossRefGoogle ScholarPubMed
Poeschmann, RP, Verheijen, RH, Dongen, PW. Differential diagnosis and causes of nonimmunological hydrops fetalis: a review. Obstet Gynecol Surv 1991; 46: 223–31.CrossRefGoogle ScholarPubMed
Steiner, RD. Hydrops fetalis: role of the geneticist. Semin Perinatol 1995; 19: 516–24.CrossRefGoogle ScholarPubMed
Beck, M, Bender, SW, Reiter, HL, et al. Neuraminidase deficiency presenting as non-immune hydrops fetalis. Eur J Pediatr 1984; 143: 135–9.CrossRefGoogle ScholarPubMed
Wy, CA, Sajous, CH, Loberiza, F, et al. Outcome of infants with a diagnosis of hydrops fetalis in the 1990s. Am J Perinatol 1999; 16: 561–7.CrossRefGoogle ScholarPubMed
Bealer, JF, Mantor, PC, Wehling, L, et al. Extracorporeal life support for nonimmune hydrops fetalis. J Pediatr Surg 1997; 32: 1645–7.CrossRefGoogle ScholarPubMed
Alpay, F, Sarici, SU, Okutan, V, et al. High-dose intravenous immunoglobulin therapy in neonatal immune haemolytic jaundice. Acta Paediatr 1999; 88: 216–19.CrossRefGoogle ScholarPubMed
Rubo, J, Albrecht, K, Lasch, P, et al. High-dose intravenous immune globulin therapy for hyperbilirubinemia caused by Rh hemolytic disease. J Pediatr 1992; 121: 93–7.CrossRefGoogle ScholarPubMed
Laneri, GG, Claassen, DL, Scher, MS. Brain lesions of fetal onset in encephalopathic infants with nonimmune hydrops fetalis. Pediatr Neurol 1994; 11: 18–22.CrossRefGoogle ScholarPubMed
Larroche, JC, Aubry, MC, Narcy, F. Intrauterine brain damage in nonimmune hydrops fetalis. Biol Neonate 1992; 61: 273–80.CrossRefGoogle ScholarPubMed
Phibbs, RH, Johnson, P, Kitterman, JA, et al. Cardiorespiratory status of erythroblastotic infants. 1. Relationship of gestational age, severity of hemolytic diseases, and birth asphyxia to idiopathic respiratory distress syndrome and survival. Pediatrics 1972; 49: 5–14.Google Scholar
Dembinski, J, Haverkamp, F, Maara, H, et al. Neurodevelopmental outcome after intrauterine red cell transfusion for parvovirus B19-induced fetal hydrops. BJOG 2002; 109: 1232–4.CrossRefGoogle ScholarPubMed
Nagel, HT, Haan, TR, Vandenbussche, FP, et al. Long-term outcome after fetal transfusion for hydrops associated with parvovirus B19 infection. Obstet Gynecol 2007; 109: 42–7.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×