History

A history suggesting the presence of any of the factors listed below should trigger an extensive diagnostic study for hydrops fetalis.

Maternal history

The following maternal factors warrant an investigation for hydrops fetalis:

Rh negative (d;d) blood type
Known presence of isoimmune blood group antibodies
Prior administration of blood products
Risks of illicit drug use
Collagen vascular disease
Thyroid disease or diabetes
Organ transplant (liver, kidney)
Blunt abdominal trauma (abuse, auto accident)
Coagulopathy
Use of indomethacin, sodium diclofenac, or potentially teratogenic drugs during pregnancy
Younger (35 years) maternal age
Risk factors for sexually transmitted diseases
Hemoglobinopathy (especially with Asian or Mediterranean ethnicity)
Occupational exposure to infants or young children
Pet cat
Current or recent community epidemic of viral illness

Family history

The following family history factors warrant an investigation for hydrops fetalis:

Prolonged or excessive jaundice in siblings as newborns
Presence of jaundice in other family members
Family history of twinning (specifically, monozygotic)
Family history of genetic disorders, chromosomal abnormalities, or metabolic diseases
Congenital malformation in previous child
Previous fetal death
Polyhydramnios or oligohydramnios in earlier pregnancies
Prior hydrops fetalis
Previous fetomaternal transfusion
Congenital heart disease in previous child

Physical Examination

The presence of any of the following maternal or fetal physical examination findings should prompt further diagnostic evaluation:

Twinning
Polyhydramnios or oligohydramnios
Exanthem or other evidence of intercurrent viral illness
Herpetic lesion or chancre
Decrease in fetal movements
Fetal tachyarrythmias

Differential Diagnoses

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Media Gallery

Chest radiograph revealing the presence of pleural effusion, severe edema, and bilateral chest tubes.
Chest and abdomen radiograph revealing the presence of severe edema and ascites.
Chest and abdomen radiograph revealing the presence of severe edema, pleural effusion, and bilateral chest tubes. An umbilical artery catheter, umbilical vein catheter, and endotracheal tube are in place.

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Author

Ashraf H Hamdan, MD, MBBCh, MSc, MRCP, FAAP Adjunct Associate Clinical Professor of Pediatrics, Vanderbilt University Medical Center; Neonatologist, Pediatrix Medical Group of Nashville

Ashraf H Hamdan, MD, MBBCh, MSc, MRCP, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Arun K Pramanik, MD, MBBS Professor of Pediatrics, 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, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Dharmendra J Nimavat, MD, FAAP Associate Professor of Clinical Pediatrics, Department of Pediatrics, Division of Neonatology, Southern Illinois University School of Medicine; Staff Neonatologist, Clinical Director, NICU Regional Perinatal Center, HSHS St John's Children's Hospital

Dharmendra J Nimavat, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Additional Contributors

David N Sheftel, MD Assistant Professor of Pediatrics, Chicago Medical School at Rosalind Franklin University of Medicine and SciencE

David N Sheftel, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Pediatrics

Disclosure: Nothing to disclose.

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 Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgements

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

Pediatric Hydrops Fetalis Clinical Presentation

History

Maternal history

Family history

Physical Examination

References

Tables

Contributor Information and Disclosures

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