A serious condition, hydrops fetalis affects a fetus or newborn baby. It causes swelling and organ failure due to an abnormal build-up of fluid in the body. It is possible to develop hydrops fetalis due to a number of factors, including blood incompatibility, infections, genetic disorders, or heart defects. The condition can be detected by ultrasound, blood tests, or biopsy. Hydrops fetalis requires a variety of treatments, depending on its severity and underlying cause. There is no cure for hydrops fetalis, and many babies die before or shortly after birth. The prognosis is poor, and many babies die before or shortly after birth.
Hydrops fetalis can be classified into two types: immune and nonimmune. The type depends on the cause of the fluid accumulation.
In immune hydrops fetalis, the mother's immune system destroys the baby's red blood cells. It can happen if the mother and baby have different blood types, such as Rh-positive or Rh-negative. This is referred to as Rh incompatibility. Immune hydrops fetalis can also occur if the mother and the baby have different antigens on their red blood cells, such as Kell, Duffy, or Kidd. This is called alloimmunization.
In nonimmune hydrops fetalis, the baby's body is unable to eliminate fluid. This can happen when the baby has a condition that affects the heart, the lungs, the blood, the lymphatic system, or the metabolism. These conditions include congenital heart defects, lung malformations, anemia, infections, chromosomal abnormalities, and metabolic disorders.
The symptoms of hydrops fetalis may vary depending on the type and the stage of the condition. Some of the common symptoms are:
Excess amniotic fluid (polyhydramnios) in the mother’s womb, which can cause abdominal pain, difficulty breathing, or preterm labor.
Abnormal or enlarged placenta, which can cause bleeding, infection, or placental abruption.
Fluid accumulation in the baby’s body cavities, such as the chest (pleural effusion), the abdomen (ascites), the heart (pericardial effusion), or the skin (anasarca). This can cause swelling, compression, or dysfunction of the organs.
Reduced or absent fetal movements, which can indicate fetal distress or death.
As part of the diagnosis process for hydrops fetalis during pregnancy, ultrasound can show the amount and location of the fluid accumulation, as well as the possible causes. In addition to measuring the baby's size and growth, ultrasound can also determine how much amniotic fluid there is, and how healthy the placenta is.
Other tests that may be done to diagnose or confirm hydrops fetalis are:
Blood tests, which can check the blood type and the antibody level of the mother and the baby, as well as the function of the liver and the kidneys.
Amniocentesis or cordocentesis, which are procedures that involve taking a sample of the amniotic fluid or the umbilical cord blood for analysis. These tests can detect infections, genetic disorders, or blood problems in the baby.
Biopsy, which is a procedure that involves taking a small piece of tissue from the placenta, the liver, or the skin for examination. This test can confirm the diagnosis of hydrops fetalis and rule out other conditions.
The treatment of hydrops fetalis depends on the cause, the severity, and the gestational age of the condition. The main goals of the treatment are to remove the excess fluid, to treat the underlying problem, and to prevent complications. Some of the possible treatments are:
Medications, which can help reduce the fluid production, the inflammation, or the infection. Some examples of these medications are diuretics, steroids, or antibiotics.
Surgery, which can help correct or bypass the obstruction, the defect, or the tumor that causes the fluid accumulation. Some examples of these surgeries are shunt placement, fetal surgery, or tumor resection.
Blood transfusion, which can help replace the lost or damaged red blood cells, or suppress the immune reaction. This can be done through the umbilical cord, the intraperitoneal cavity, or the intravascular space.
Delivery, which can be done by induction of labor or cesarean section, depending on the condition of the mother and the baby. Delivery may be necessary if the hydrops fetalis is severe, if the baby is mature enough, or if there is a risk of maternal or fetal complications.
There is no sure way to prevent hydrops fetalis, as it can have many different causes. However, some general measures that may help reduce the risk or the severity of hydrops fetalis are:
If you have a family history of hydrops fetalis or other blood disorders, you should seek prenatal care and genetic counseling. Genetic counseling can help determine the chances and options for having a baby with hydrops fetalis by monitoring the baby's health and development. Prenatal care can also help monitor the baby's development.
Pregnancy-related substances and infections, such as alcohol, drugs, mercury, rubella, and toxoplasmosis, should be avoided. Infections or substances such as these may interfere with the baby's normal development and blood vessels, increasing the risk of hydrops fetalis.
By getting vaccinated against Rh incompatibility, mothers and babies can avoid the immune reaction that causes hydrops fetalis. Rh-negative women who are pregnant or planning to become pregnant, as well as those who have not been sensitized to Rh-positive blood, are given the vaccine as an injection during pregnancy or after delivery.
