Hydrops

1. Hydrops Dr. Tarek Sayed

2. Objectives What is hydrops fetalis ? What causes hydrops fetalis ? Who is affected by hydrops fetalis ? What are the symptoms of hydrops fetalis ? Why is hydrops fetalis a concern ? How is hydrops fetalis diagnosed ? Treatment for hydrops fetalis :

3. What is hydrops fetalis ? Hydrops fetalis is a severe, life-threatening problem of severe edema (swelling) in the fetus and newborn. It is also called hydrops . Presence of excess extra-cellular fluid in two or more sites Pericardial effusion Pleural Effusion Ascites Placental Enlargement

4. Non-immune Hydrops Fetalis

5. What causes hydrops fetalis ? Hydrops develops when too much fluid leaves the bloodstream and goes into the tissues. Many different diseases and complications can cause hydrops , including the following : Immune: Hydrops can develop as the baby's organs are unable to compensate for the anemia. The heart begins to fail and large amounts of fluid build up in the baby's tissues and organs .

6. What causes hydrops fetalis ? non-immune  :  includes all other diseases or complications that may interfere with the baby's ability to manage fluid. There is no one mechanism to explain non-immune hydrops . Some of the diseases or complications that are often associated with hydrops include the following: severe anemias congenital infections (infections present at birth) heart or lung defects chromosomal abnormalities and birth defects liver disease renal disease

7. P athogenesis Three main hypothesis : Anemia Cardiac Failure Reduction in Osmotic Pressure ( Hypoproteinaemia

8. Pathogenesis Fetal Anemia: High output cardiac failure Increase in umbilical venous pressure Portal hypertension in severely effected fetuses due to increase in hepatic erythropoetic tissue. Hypoxia and acidosis predispose to epithelial damage in capillaries that allows loss of fluid to extravascular comp

9. P athogenesis Fetal Anemia: Alpha ( ) Thalasaemia Secondary to Feto -maternal Hemorrhage Twin-twin transfusion Other Hemoglobinopathies

10. Pathogenesis Cardiac Failure: Commonest Mechanism Increase in Cardiac Size Increased Fetal Venous Pressure Causes include: Cardiomyopathies Tachyarythmias Bradycardias (Congenital heart block) Obstructive left heart disease Ebstien’s anomaly Atrial isomerism

11. Pathogenesis Reduced Osmotic pressure : Hypoproteiaemia with Subsequent Reduction in Osmotic Pressure Anemia Along With Destruction of Hepatic Architecture Congenital Nephrosis

12. Pathogenesis Other : Obstruction to venous return Congenital cystic adenomatoid malformation of lung Impaired lymphatic drainage Cystic hygroma Karyotypic abnormalities (45XO) Connective tissue malformation Fetal Infections: TORCH Parvo Virus B19

13. Who is affected by hydrops fetalis ? Immune hydrops is not as common  Non-immune hydrops occurs rarely . The incidence of hydrops can vary between populations

14. Why is hydrops fetalis a concern?  About half of unborn babies with hydrops do not survive Risks are also high for babies born with hydrops , with survival often depending on the cause and treatment.

15. What are the symptoms of hydrops fetalis ? During pregnancy, symptoms may include : large amounts of amniotic fluid thickened placenta ultrasound of the fetus shows enlarged liver, spleen, or heart, and fluid buildup in the fetus' abdomen After birth, symptoms may include : pale coloring severe edema overall, especially in the baby's abdomen enlarged liver and spleen respiratory distress 

16. How is hydrops fetalis diagnosed ? complete medical history and physical examination diagnostic procedures for hydrops fetalis may include : Ultrasound fetal blood sampling   amniocentesis   Fetal echo Placental thickness

17. Treatment for hydrops fetalis :   based on:  gestational age, overall health, and medical history Extent of the disease Treatment of hydrops depends on the cause help for respiratory distress  removal of excessive fluid from spaces medications to help the kidneys remove excess fluid

18. Soft Tissue shadow and pleural effusion in hydropic neonate

19. Thank you