NON IMMUINE HYDROPS FETALIS UNIT IV

DR VARSHA DESHMUKH

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HISTORY

• 25 Yrs. Old• 7 Months Amenorrhoea• Swelling of Feet 1 month• Headache 3 days

OBST. HISTORY

• G5 P4 L1 A0• First 3 Preterm deliveries all died.• 4th FTND 3 year old female live KAY

GENERAL EXAMINATION• GC Moderate, afebrile, pulse 96 /min., BP – 150/110 mm.Hg.• Pallor +, Edema +• CVS, RS wnl • Per abdomen • Ut over distended, tense, fetal parts not felt, FHS CNL• Per Vaginum Cx 1 Fl, 60 % Effaced, Membranes + breech at – 2 St.• Pelvis adequate • Provisional Diagnosis G5 P4 L1 A0, Sev. PIH, ? Twins ? Hydramnios• Ultrasonography KAY

Ultrasonography

KAY1. Placental Oedema 2. Scalp Oedema

Ultrasonography

KAY1. Ascitic Fluid 2. Liver 3. Peri. Effusion

LABOUR NOTES

• Preterm Vaginal Delivery on 11/7/2003 (within 7 hrs.of active labour)

• Female child 2200 gm., MSB, e/o Hydrops Fetalis +

• Hyperplacentosis +, WT 1500 gm

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INVESTIGATIONS

• Bld gr Orh+ve • Hemogram Normal • LFTs, KFTs Wnl • BSL Normal• Urine Exam. Normal• Findings of neonatal autopsy :• Macerated baby, distension of abd, edema all over body, peeling of skin.• Pericardial effusion, fluid in peritoneal cavity 200 cc.• Congested liver, lungs, spleen, kidneys• diagnosis – non immunize hydrops fetalis

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INTRODUCTION

Potter in 1943 described clinical entity, thataffected non-Rh sensitised pregnancies,  

NIH –1) Fetal ansarca.2) Placental oedema3) Fetal serous effusions

NIH does not represent a specific disease. “Late manifestation of many severe diseases”. KAY

ETIOLOGY

• Cardiovascular anomalies - tachyarrhythmia, Anatomic defects

• Chromosomal - Down syndrome, Turner Syndrome.

• Malformation syndrome• Twin pregnancy- Twin transfusion

syndrome• Hematologic - Arteriovenous shunt• Genitourinary - Congenital nephrosis

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ETIOLOGY

• Respiratory - Pulmonary hypoplasia• Gastrointestinal• Liver• Maternal - Severe diabetes mellitus,

severe anemia, Hypoproteinemia• Placenta-umbilical cord - Chorionic vein

thrombosis• Medications - Antepartum indomethacin• Infectious - Parvovirus B 19, TORCH• Miscellaneous KAY

DIAGNOSIS

• Ultrasound evaluation.

• Skin thickness more than 5 mm.

• Placental thickness more than 4 cm

• Ascitis, pericardial effusion, pleural effusion.

• Polyhydramnios. KAY

MANAGEMENTAll NIH should be referred to a unit where

facilities exist for detailed anomaly scans including - echocardiography, fetal blood sampling and tertiary neonatal care.

Principles of Management• If detected at <20 wks option for

termination of pregnancy given.• Establish underlying cause• Determine appropriate therapy & optimal

timing of therapy.Prognosis :Overall mortality ranges 50% - 90% .

CONCLUSION

• USG has a pivotal role in diagnosis.• Generalised lymphoedema has a poor

prognosis • Cardiovascular anomalies is the most

identifiable cause. Arrhythmias are amenable to therapy.

• Knowledge of etiology and fetal karyotype will determine whether aggressive management is warranted.

• Parent’s of affected child, need counselling regarding accurate diagnosis and prognosis.