Makindo Medical Notes

Most cases prevented by use of immunoglobulin (Ig) prophylaxis in at-risk mothers.

About

• A severe condition seen in the fetus characterized by abnormal accumulation of fluid
• If untreated, hydrops fetalis can lead to fetal heart failure, organ damage, and in many cases, stillbirth.
• Hydrops fetalis is characterized by fluid accumulation in more than two fetal body compartments.
• Common sites of fluid accumulation include ascites, pleural effusion, pericardial effusion, and skin oedema.

Aetiology

• Immune Causes (Erythroblastosis Fetalis): Primarily due to Rh blood group isoimmunization, where maternal antibodies attack fetal red blood cells.
• Non-Immune Causes: These include chromosomal anomalies, liver disease, heart or lung disorders, and infections (e.g., parvovirus B19, cytomegalovirus, syphilis).

Risk Factors

• Maternal Rh-negative status with an Rh-positive fetus, leading to isoimmune antibody formation.
• Previous administration of blood products, which can increase sensitization risks.
• Substance abuse, medications such as Indomethacin, and maternal collagen-vascular disease.
• Extremes of maternal age, including young mothers (<16 years) or older mothers (>35 years).

Clinical Presentation

• Severe fetal anaemia, often resulting in high-output cardiac failure.
• Fetal haemorrhage with hepatosplenomegaly (enlarged liver and spleen).
• Significant abdominal swelling due to ascites and pleural/pericardial effusions.
• Skin oedema as a result of fluid overload and cardiac insufficiency.

Investigations

• Ultrasound (USS): In the 1st or 2nd trimester, reveals fluid collections, polyhydramnios, and placental oedema, along with enlargement of the liver, spleen, and heart.
• Fetal Blood Sampling: Performed by inserting a needle through the uterus into a fetal blood vessel or umbilical cord to assess fetal haemoglobin and other parameters.
• Amniocentesis: Involves withdrawing a sample of amniotic fluid to test for chromosomal abnormalities or infections.

Management

• Prevention: Administration of immunoglobulin (Ig) prophylaxis in Rh-negative mothers significantly reduces immune-related hydrops fetalis cases.
• Delivery: Often by Caesarean section, with resuscitation, intubation, and ventilation support prepared if needed.
• Neonatal Care:
  • Ventilation and oxygen support to manage respiratory distress.
  • Transfusions to address severe anaemia and improve fetal oxygenation.
  • Management of hypoglycaemia and drainage of any ascites or pleural effusions as needed.
  • Administration of Vitamin K to prevent bleeding and Furosemide to manage fluid overload.