What Is Fetal Hydrops?
A fetus or baby with hydrops fetalis has an abnormal accumulation of fluid in the tissue surrounding the lungs, heart, belly, or under the skin. This disorder is dangerous and life-threatening. The body's ability to regulate fluids is typically impacted by a side effect of another medical disease. One newborn out of every 1,000 has hydrops fetalis. The doctor may induce early labor and deliver the baby if the woman is pregnant and the unborn child has hydrops fetalis. A blood transfusion and other treatments to drain the extra fluid may be required for a newborn with hydrops fetalis. Even with care, over half of infants with hydrops fetalis will pass away just before or right after birth.
What Are the Causes of Fetal Hydrops?
There are two kinds of hydrops fetalis: immune and nonimmune. The kind will vary depending on what caused the abnormal fluid.
Most frequently, a severe form of Rh incompatibility, which is preventable, leads to immune hydrops fetalis. When a mother with a Rh-negative blood type develops antibodies against her baby's Rh-positive blood cells, the antibodies pass through the placenta. Hemolytic illness of the newborn is another name for the Rh incompatibility condition that results in a significant loss of red blood cells in the developing infant. This causes issues such as swelling throughout the body. Significant swelling can affect how the body's organs function.
Nonimmune hydrops fetalis is more prevalent. As many as 90 percent of cases of hydrops are caused by it. The illness develops when a sickness or other medical issue impairs the body's capacity to regulate fluid. This type is primarily brought on by three conditions: heart or lung issues, severe anemia (from thalassemia or infections, for example), and hereditary or developmental issues, which include Turner syndrome.
What Are the Symptoms of Fetal Hydrops?
The severity of the illness affects the symptoms.
Mild forms could lead to:
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Liver enlargement.
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Skin tone modification (pallor).
More severe types could result in:
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Breathing difficulties.
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Bruising or purple patches on the skin that resemble bruises.
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Severe anemia.
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Jaundice that is extremely severe.
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Swelling throughout the body.
How to Diagnose Fetal Hydrops?
Hydrops fetalis is typically diagnosed via an ultrasound. A doctor might detect hydrops fetalis during a typical prenatal exam on an ultrasound. High-frequency sound waves are used during an ultrasound to assist in capturing real-time images of the inside of the body.
Additional diagnostic tests might be performed to help identify the severity or source of the disease. These consist of:
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Fetal blood testing.
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Amniotic fluid is removed by a procedure called amniocentesis to be tested further.
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Fetal echocardiography, which scans for heart structural flaws.
How to Manage Fetal Hydrops?
Given the significant risk of fetal death, the woman should be transferred to a high-risk facility for additional management and multidisciplinary counseling if the prenatal diagnosis is made. Obstetric and neonatal doctors must work closely together. If a premature birth is predicted, prenatal steroids should be given.
1. Intervention at the Fetal Stage:
Fetal transfusion for severe fetal anemia, maternal antiarrhythmic drugs (like digoxin) for fetal arrhythmia, and in-utero surgery (such as fetal thoracocentesis or paracentesis and surgical resection) are all potential fetal procedures. Procedures designed to address the underlying pathophysiology causing fetal hydrops make high-risk treatments simpler to accept. Therefore, the most widely accepted management strategies are designed to stop fetal blood loss, regardless of cause, fetal transfusion to treat anemia, medication therapy for cardiac arrhythmias, and correction or reduction of space-occupying lesions that obstruct cardiac venous or lymphatic return.
a) Fetal Arrhythmias: Fetal arrhythmias have been treated by doing nothing, giving medications, and delivering the baby immediately. The simplest and most direct method is to birth the afflicted fetus and treat the arrhythmia directly in the newborn if fetal maturity allows. Medications have typically been seen as appropriate when fetal immaturity prevents this strategy.
b) Fetal Anemia:
- Intrauterine IP (Intraperitoneal) Fetal Transfusion: A recent achievement in perinatal medicine is the intrauterine IP fetal transfusion with packed red blood cells (PRBCs) used to treat the highly anemic fetus of an isoimmunized pregnancy. Intrauterine IP fetal transfusion has been used successfully to treat fetal anemia caused by various conditions, including heavily vascularized tumor masses, marrow aplasia associated with severe fetal infection, and hemoglobinopathy. Once more, it is unclear if this is the case or merely the result of biased reporting. However, the standard therapy for fetuses with severe anemia is now fetal transfusion via the IP route.
- Umbilical Vein (UV) Intravascular Transfusion: The preferred method for treating fetal anemia has changed from Intraperitoneal (IP) transfusion to intravascular (UV) transfusion of packed RBCs. Following cross-matching with the mother's serum, packed RBCs are administered through slow-push infusion.
c) Space-Occupying Masses: One of the more significant causes of fetal hydrops is space-occupying tumors that hinder lymphatic or venous return. Depending on the lesion type and the center, management differs. However, when fast delivery is impractical, the reduction or removal of the mass has traditionally served as the primary basis for most treatments.
2. Management of the Perinatal Period:
The neonatologist faces a distinct set of challenges in managing hydrops fetalis during resuscitation and in the delivery room. As soon as a fetus is found to have hydrops, the obstetrician and neonatologist must collaborate. Take note of the following:
- Once hydrops have been detected antenatally, make every attempt to determine the reason; this will aid in treating the infant at birth. Before giving birth, do or repeat a prenatal ultrasonographic examination to determine whether pleural effusion, pericardial effusion, or ascites are present and how severe they are. This is important because the fluid may need to be aspirated in the delivery room to create appropriate ventilation and circulation.
- A qualified team of experienced healthcare experts (neonatologists, nurses, respiratory therapists, radiograph technicians, and ultrasonography technicians) should also be present in the delivery room, in addition to the necessary tools and supplies.
- Notify the blood bank or prepare type O-negative blood for prompt transfusion through umbilical catheters in the delivery room. A PRBC transfusion may enhance resuscitation outcomes and save the life of a very anemic fetus. Take blood samples for a Complete Blood Cell count (CBC), newborn diagnostic screening, and other laboratory procedures before the blood is transfused if blood transfusion is necessary in the delivery room.
- Install umbilical arterial and venous catheters to measure the infant's arterial pressure, blood gases, and venous pressure after securing the airway and ventilation.
- The Neonatal Intensive Care Unit (NICU) should have PRBCs or whole cross-matched blood for transfusion to treat severe anemia.
- Recognize and quickly address metabolic disorders such as acidosis and hypoglycemia.
- Hydrops may be related to surfactant shortage and hypoplastic lungs, which are treated accordingly.
- It could be required to drain the pleural and abdominal cavities of pleural and ascitic fluid, respectively, in order to ventilate the baby effectively.
Conclusion:
The condition known as hydrops fetalis is a sign of numerous birth abnormalities. It can also develop due to a mother and child's blood being incompatible due to variations in the Rh factors in their blood. Expect close observation and testing until delivery for mothers whose babies have this issue. Based on fetal symptoms, the timing of birth is to be optimized. Different treatments and results may be suggested depending on the health issue that is causing the issue.
