eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Hydrops Fetalis: Follow-up

Author: Ashraf H Hamdan, MB, BCh, MSc, MD, MRCP, Clinical Assistant Professor of Pediatrics, Vanderbilt University Medical Center
Contributor Information and Disclosures

Updated: Aug 20, 2008

Follow-up

Further Inpatient Care

  • If the precipitating cause was profound anemia, red cell survival may remain reduced in patients with isoimmune hemolytic anemia, and red cell production may be impaired in the fetus or newborn who has received multiple red cell transfusions.
  • If the cause of hydrops fetalis was a treatable infection, assurance of total eradication of the offending agent is obviously necessary.
  • In situations in which multiple anomalies and/or chromosomal abnormalities are present, family counseling is recommended.
  • Follow-up measures targeted toward the specific pathophysiologic disturbances present in individual cases may be required (eg, any baby who has experienced a compromised perinatal period).
  • Despite the profound compromise in perfusion and fetal function of multiple organ systems in the fetus with hydrops, the limited follow-up data that are currently available provide an unexpectedly optimistic outlook for babies who survive fetal hydrops.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Unique medicolegal issues primarily concern the difficult access to the fetus.
  • The keystone of management of hydrops fetalis is developing parental knowledge and understanding of all choices to obtain truly informed consent. Because the fetal condition is always urgent and time is short, development of this parental knowledge and understanding may represent a considerable challenge.
    • Medications given to the mother place her at risk; however, the same medications may ultimately reach the fetus in concentrations too low to be effective. In addition, a standard therapy has yet to be established.
    • The option of direct fetal access for drug administration has often been used; however, the invasive methods used inevitably place both mother and fetus at increased risk.
    • Similarly, direct fetal surgical maneuvers carry more risk for the fetus than similar procedures performed after birth; direct fetal surgical maneuvers also place the mother at increased risk.
    • Finally, inadvertent harm to the fetus places the clinician at risk for a considerably longer period than is usual.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, George Cassady, MD, to the development and writing of this article.



More on Hydrops Fetalis

Overview: Hydrops Fetalis
Differential Diagnoses & Workup: Hydrops Fetalis
Treatment & Medication: Hydrops Fetalis
Follow-up: Hydrops Fetalis
Multimedia: Hydrops Fetalis
References
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Further Reading

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Keywords

hydrops foetalis, hydrops, fetal hydrops, universal edema of the newborn, nonimmune hydrops, fetal edema, fetal subcutaneous tissue edema, placental edema, hydramnios, maternal-fetal blood group incompatibilities, maternal isoimmunization to fetal blood group antigens, isoimmune hemolytic disease, immune hydrops, homozygous alpha-thalassemia, Bart hydrops, congenital malformations, premature delivery, fetal fluid accumulations, fetal thoracentesis

fetal paracentesis, fetal surgical procedures, maternal ABO-factor isoimmunization, Rh D hemolytic disease, drug use, collagen disease, thyroid disease, diabetes, organ transplant, blunt abdominal trauma, coagulopathy, use of teratogenic drugs, sexually transmitted diseases, hemoglobinopathy, viral illness, fetomaternal transfusion, herpetic lesions, chancre, hemolytic disease of newborn, erythroblastosis, glucose phosphate isomerase deficiency, pyruvate kinase deficiency, G-6-PD deficiency, congenitaldyserythropoietic anemia, Diamond-Blackfan syndrome, lethal hereditary spherocytosis, spectrin synthesis defects, congenital erythropoietic porphyria

Günther disease, leukemia with Down syndrome, leukemia with Noonan syndrome, Bart hemoglobinopathy, Parvovirus B19, B19V, intracranial hemorrhage, intraventricular hemorrhage, hepatic laceration, placental subchorial hemorrhage, sacrococcygeal teratoma, fetomaternal hemorrhage, twin-to-twin transfusion, isoimmune fetal thrombocytopenia, fetal anemia, fetal aplastic anemia, malformation syndromes, fetal hemorrhage, placental choriocarcinoma, placental chorangioma, partial placental abruption

reduced fetal body movements, sinusoidal fetal heart rate patterns, fetal acardia, fetus papyraceous, stuck twin, vanishing twin, velamentous cord insertion, atrial natriuretic factor, fetal meconium peritonitis, lysosomal storage disorders, cystic hygroma, cystic adenomatoid malformation of the lung, fibroelastosis, prenatal closure of foramen ovale, prenatal closure of ductus arteriosus, idiopathic arterial calcification, AV block, atrial flutter, tachyarrhythmia, congenital heart block, maternal collagen disease, congenital syphilis, lethal multiple pterygium syndromes, fetal coagulopathy, bronchopulmonary sequestration, tension hydrothorax

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Contributor Information and Disclosures

Author

Ashraf H Hamdan, MB, BCh, MSc, MD, MRCP, Clinical Assistant Professor of Pediatrics, Vanderbilt University Medical Center
Ashraf H Hamdan, MB, BCh, MSc, MD, MRCP is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

David N Sheftel, MD, Director, Division of Neonatology, Clinical Associate Professor, Department of Pediatrics, Lutheran General Children's Hospital of Park Ridge, Chicago Medical School
David N Sheftel, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Arun K Pramanik, MD, MBBS, Professor of Pediatrics, Director of Neonatal Fellowship, Louisiana State University Health Sciences Center
Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Carol L Wagner, MD, Professor of Pediatrics, Medical University of South Carolina
Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD, Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine
Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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