3. Fetal Hydrops
• Accumulation edema fluid; Non-immune causes (CVS,
Chromosomal and Fetal anemia) are MC; Hydrops fetalis =
generalized edema;
• Immune type
• Nonimmune type
• Three major causes
– parvovirus B19
– α-thalassemia
– cardiovascular defects, chromosomal anomalies, and fetal anemia
3
Dr. Krishna Tadepalli, MD, www.mletips.com
4. Fetal Hydrops
•
Accumulation edema fluid; Non-immune causes (CVS, Chromosomal and Fetal
anemia) are MC; Hydrops fetalis = generalized edema;
• Immune type
4
Dr. Krishna Tadepalli, MD, www.mletips.com
5. Fetal Hydrops
• Immune type
•
•
•
•
MC is Rh (mainly D Antigen) incompatibility between mother and fetus
Incidence is decreased in urban societies ( why?)
Factors influence immune response =
– Concurrent ABO incompatibility protects
– depends on the dose of immunizing antigen (> 1 ml of Rh-positive fetal red
cells)
– subsequent pregnancy has the risk
Pathology
– Anemia due to hemolysis (extramedullary hematopoiesis )
– Jaundice due to hemolysis ( unconjugated bilirubin) kernicterus
– hypoxic injury to the heart and liver cardiac decompensation and failure
generalized edema and anasarca
5
Dr. Krishna Tadepalli, MD, www.mletips.com
6. Fetal Hydrops
• Nonimmune type (table-10.4)
•
•
Three major causes (cardiovascular defects, chromosomal anomalies, and fetal
anemia ;- α- thalassemia &parvovirus B19)
Morphology
–
–
–
–
stillborn, die within the first few days, or recover
Pale fetus and placenta (due to fetal anemia)
liver and spleen are enlarged ( due to congestion from cardiac failure)
bone marrow hyperplasia of erythroid precursors & extramedullary hematopoiesis
(compensatory)
– Erythroblastosis fetalis =large numbers of immature red cells, including reticulocytes,
normoblasts, and erythroblasts in peripheral circulation
– blood bilirubin level greater than 20 mg/dL in term infants
– Kernicterus =most serious; brain is enlarged and edematous and bright yellow in
color; affects mainly basal ganglia, thalamus, cerebellum, cerebral gray matter, and
spinal cord
•
•
Clinical = vary with the severity of the disease from Hepatosplenomegaly to
Kernicterus
Rx = for mild cases -phototherapy (visual light oxidizes unconjugated bilirubin6)
and total exchange transfusion for severe cases
Dr. Krishna Tadepalli, MD, www.mletips.com
