eMedicine Specialties > Radiology > Obstetrics/Gynecology

Hydrops Fetalis: Follow-up

Author: Durre Sabih, MBBS, MSc, Visiting Faculty, Department of Nuclear Medicine, Pakistan Institute Applied Sciences and Nishtar Medical College; Director, Multan Institute of Nuclear Medicine and Radiotherapy
Coauthor(s): Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Zahida Sabih, MBBS, MSc,
Contributor Information and Disclosures

Updated: Jul 16, 2008

Intervention

The mainstay of treatment of fetal hydrops is interventional fetal therapy. In a few patients, drugs administered to the mother elicit a response and reach the fetus transplacentally. In fetuses with IHF, treatment essentially involves correcting fetal anemia. In all patients, fetal anemia associated with hydrops fetalis is an absolute indication for fetal blood sampling followed by in utero transfusion.24 Ultrasonographic guidance is essential for fetal blood transfusion. For this procedure, intravascular transfusion (IVT) is preferred over the intraperitoneal route.

Of the many methods available, the prognosis is better in fetuses receiving IVT than in those receiving intraperitoneal transfusions because peritoneal absorption is often impaired in affected fetuses. With IVT, 70-85% of fetuses with hydrops and 85-95% of fetuses without hydrops can survive.25 The therapy associated with the highest incidence of consistent benefit to the fetus is correction of fetal anemia via fetal blood transfusions.

Treatment in patients with NIHF is more complex and must be directed at the cause. One way to classify treatments is to separate them into noninvasive and invasive categories.

  • Noninvasive treatment may include the following:
    • Antiarrhythmic drugs7,19,26,27
    • Antibiotics
    • Correction of maternal diabetes28 and hyperthyroidism15
  • Invasive treatment – The aggressiveness with which the following treatments are performed depends on the resources, sophistication, and experience of the treating unit. Some attempted procedures include the following:
    • Correction of fetal anemia in fetal hemorrhages, parvovirus infections and, possibly, thalassemia
    • Amnioreduction by means of serial amniocentesis
    • Fetoscopic laser ablation of communicating vessels in twin-twin transfusion syndrome
    • Cord occlusion in cardiac twins
    • Thoracocentesis in chylothorax and large pleural collections
    • Vesicoamniotic drainage in urinary tract obstructions
    • Fetal surgery to correct diaphragmatic hernias and sacrococcygeal teratomas29

Remember that the appearance of the features of hydrops fetalis usually signals an advanced stage in the progression of the disease, and the prognosis is poor in most fetuses. However, specialists in fetal medicine and intervention should be consulted in all cases to decide if therapy is appropriate and, if it is, to determine which therapy to use.

Medicolegal Pitfalls

  • Some causes of hydrops fetalis lead to disease in subsequent pregnancies, with the attendant psychologic and emotional stress on parents.
  • Trying to arrive at an accurate diagnosis is essential in all patients to identify the possibility of recurrence in later pregnancies.
    • Several conditions leading to hydrops fetalis can recur in subsequent pregnancies; the most significant is Rh isoimmunization.
    • Many cases of NIHF can also recur, and every case should be discussed with a geneticist to assign a probability of recurrence.
    • The parents should be informed during counseling sessions.
  • An accurate diagnosis may not always be possible, and this limitation must be clearly explained to parents of affected fetuses who opt for another pregnancy.
 


More on Hydrops Fetalis

Overview: Hydrops Fetalis
Imaging: Hydrops Fetalis
Follow-up: Hydrops Fetalis
Multimedia: Hydrops Fetalis
References
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References

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  13. Spear GS, Beutler E, Hungs M. Congenital Gaucher disease with nonimmune hydrops/erythroblastosis, infantile arterial calcification, and neonatal hepatitis/fibrosis. Clinicopathologic report with enzymatic and genetic analysis. Fetal Pediatr Pathol. May-Jun 2007;26(3):153-68. [Medline].

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  21. Harper A, Kenny B, O'Hara MD, Nelson J. Recurrent idiopathic non-immunologic hydrops fetalis: a report of two families, with three and two affected siblings. Br J Obstet Gynaecol. Aug 1993;100(8):796. [Medline].

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  23. Favre R, Dreux S, Dommergues M, et al. Nonimmune fetal ascites: a series of 79 cases. Am J Obstet Gynecol. Feb 2004;190(2):407-12. [Medline].

  24. Hsieh FJ, Chang FM, Ko TM, Chen HY. Percutaneous ultrasound-guided fetal blood sampling in the management of nonimmune hydrops fetalis. Am J Obstet Gynecol. Jul 1987;157(1):44-9. [Medline].

  25. Harman CR, Bowman JM, Manning FA, Menticoglou SM. Intrauterine transfusion--intraperitoneal versus intravascular approach: a case-control comparison. Am J Obstet Gynecol. Apr 1990;162(4):1053-9. [Medline].

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  28. Greco P, Vimercati A, Giorgino F, Loverro G, Selvaggi L. Reversal of foetal hydrops and foetal tachyarrhythmia associated with maternal diabetic coma. Eur J Obstet Gynecol Reprod Biol. Nov 2000;93(1):33-5. [Medline].

  29. Walsh DS, Adzick NS. Fetal surgical intervention. Am J Perinatol. 2000;17(6):277-83. [Medline].

  30. Castellino SM, Powers R, Kalwinsky D, DeVoe M. Abdominal rhabdoid tumor presenting as fetal hydrops: a case report. J Pediatr Hematol Oncol. May 2001;23(4):258-9. [Medline].

  31. Harman CR, Manning FA, Bowman JM, Lange IR, Menticoglou SM. Use of intravascular transfusion to treat hydrops fetalis in a moribund fetus. CMAJ. May 1 1988;138(9):827-30. [Medline]. [Full Text].

  32. Turski DM, Shahidi N, Viseskul C, Gilbert E. Nonimmunologic hydrops fetalis. Am J Obstet Gynecol. Jul 1 1978;131(5):586-7. [Medline].

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Further Reading

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Keywords

hydrops fetalis, fetal hydrops, edema of the fetus, nonimmune hydrops erythroblastosis fetalis, universal edema of the newborn, neonatal edema, fetal edema, immune hydrops fetalis, IHF, immune-related hydrops fetalis, nonimmune hydrops fetalis, NIHF, nonimmune-related hydrops fetalis, crocodile skin, α thalassemia, alpha thalassemia

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Contributor Information and Disclosures

Author

Durre Sabih, MBBS, MSc, Visiting Faculty, Department of Nuclear Medicine, Pakistan Institute Applied Sciences and Nishtar Medical College; Director, Multan Institute of Nuclear Medicine and Radiotherapy
Disclosure: Nothing to disclose.

Coauthor(s)

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Zahida Sabih, MBBS, MSc, 
Disclosure: Nothing to disclose.

Medical Editor

Christopher L Sistrom, MD, Associate Chair for Research, Assistant Professor, Department of Radiology, University of Florida School of Medicine
Christopher L Sistrom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Association of University Radiologists, Phi Beta Kappa, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Karen L Reuter, MD, FACR, Professor, Department of Radiology, Lahey Clinic Medical Center
Karen L Reuter, MD, FACR is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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