Aetiology, Diagnosis and Treatment of Hydrops Foetalis

Abstract

Hydrops foetalis is defined as a state of excessive fluid accumulation in the extravascular compartment of the foetus, leading to widespread soft tissue oedema and/or accumulation of fluid in the foetal body cavities. The prognosis of hydrops foetalis is highly dependent on the underlying pathology and early diagnosis is essential to identify treatable cases. The classification of immune and non-immune hydrops foetalis describes the difference between Rhesus haemolytic disease of the newborn and other aetiologies leading to hydrops foetalis. With improved diagnosis and treatment of Rhesus iso-immunisation, non-immune factors have become more frequent. Distinction between anaemic and non-anaemic hydrops foetalis provides a far more useful differentiation between aetiologies. This approach is used to discuss differential diagnosis, work-up and therapeutic options in hydrops foetalis. A structured multidisciplinary work-up will facilitate early diagnosis and assist in making treatment decisions.

Parvovirus B19 infection in pregnancy

“…Symptoms such as erythema infectiosum, mild fever, arthralgia and headache start approximately 10-14 days after infection in about 50% of infected women. At the time of the occurrence of IgM antibodies, presumably during the maternal peak viral load (day 7), the risk of vertical transmission may be maximal (De Haan et al, 2005). Until now, the exact route of transmission is unknown.…”

In Utero Treatment of Severe Fetal Anaemia due to Parvovirus B19 in One Fetus in a Twin Pregnancy – A Case Report and Literature Review

“…Maternal viraemia reaches its peak approximately 1 week after B19 infection. Maternal IgM antibodies appear during the maternal peak viral load (day 7) when the risk of vertical transmission may be maximal [2,3] . B19-specific IgM antibodies become detectable in the maternal circulation within 7-10 days after infection, sharply peak at 10-14 days and then rapidly decrease within 2-3 months [4] .…”

Congenital chylothorax: current perspectives and trends

“…28 In CC, NIHF may develop from a combination of increased capillary filtration rate (caused by increased capillary hydrostatic pressure) and reduced lymphatic clearance that occurs with elevated central venous pressure secondary to vena caval obstruction or because of interference with cardiac function caused by the mass effect of the chylous effusion. 29,30 It may also result from decreased …”

“…29 Lymphangiectasia and other congenital lymphatic malformations (lymphatic dysplasia syndrome, lymphangiomas, and cervical or cystic hygromas) can also present with chylothorax/bilateral pleural effusions, and NIHF as a result of obstruction in lymphatic flow. [31][32][33] Cystic hygromas are commonly associated with complex aberrations of the lymphatics and cause mass compression effects that impede both lymphatic drainage and venous return to the heart.…”