Hydrops fetalis is a severe condition where excess fluid builds up in fetal tissues. It can be caused by immune or non-immune factors. Immune hydrops is caused by fetal anemia from blood incompatibility between mother and fetus, while non-immune hydrops can result from conditions like infections, heart defects, or genetic abnormalities. Symptoms include excess amniotic fluid and swelling visible on ultrasound. After birth, symptoms are pale skin, edema, enlarged organs, and respiratory distress. Diagnosis involves ultrasounds, blood tests, and other procedures to investigate potential causes. Treatment depends on the underlying cause but may include help with breathing, removing excess fluid, and kidney support.

1. Hydrops
Dr. Tarek Sayed

2. Objectives
What is hydrops fetalis ?
What causes hydrops fetalis ?
Who is affected by hydrops fetalis ?
What are the symptoms of hydrops fetalis ?
Why is hydrops fetalis a concern ?
How is hydrops fetalis diagnosed ?
Treatment for hydrops fetalis :

3. What is hydrops fetalis ?
• Hydrops fetalis is a severe, life-threatening problem of
severe edema (swelling) in the fetus and newborn. It is also
called hydrops.
• Presence of excess extra-cellular fluid in two or more
sites
 Pericardial effusion
 Pleural Effusion
 Ascites
 Placental Enlargement

4. Non-immune Hydrops Fetalis

5. What causes hydrops
fetalis?
• Hydrops develops when too much fluid leaves the
bloodstream and goes into the tissues. Many different
diseases and complications can cause hydrops, including the
following:
• Immune:
• Hydrops can develop as the baby's organs are unable to
compensate for the anemia. The heart begins to fail and
large amounts of fluid build up in the baby's tissues and
organs.

6. What causes hydrops fetalis ?
• non-immune :
includes all other diseases or complications that may interfere
with the baby's ability to manage fluid. There is no one
mechanism to explain non-immune hydrops. Some of the
diseases or complications that are often associated with
hydrops include the following:
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severe anemias
congenital infections (infections present at birth)
heart or lung defects
chromosomal abnormalities and birth defects
liver disease
renal disease

7. Pathogenesis
• Three main hypothesis:
Anemia
Cardiac Failure
Reduction in Osmotic Pressure
(Hypoproteinaemia

8. Pathogenesis
• Fetal Anemia:
 High output cardiac failure
Increase in umbilical venous pressure
 Portal hypertension in severely effected
fetuses due to increase in hepatic
erythropoetic tissue.
 Hypoxia and acidosis predispose to epithelial
damage in capillaries that allows loss of fluid
to extravascular comp

9. Pathogenesis
• Fetal Anemia:
 Alpha ( ) Thalasaemia
 Secondary to Feto-maternal Hemorrhage
 Twin-twin transfusion
 Other Hemoglobinopathies

10. Pathogenesis
Cardiac Failure:
Commonest Mechanism
Increase in Cardiac Size
Increased Fetal Venous Pressure
Causes include:
Cardiomyopathies
Tachyarythmias
Bradycardias (Congenital heart block)
Obstructive left heart disease
Ebstien’s anomaly
Atrial isomerism

11. Pathogenesis
Reduced Osmotic pressure:
Hypoproteiaemia with Subsequent
Reduction in Osmotic Pressure
Anemia Along With Destruction of Hepatic Architecture
Congenital Nephrosis

12. Pathogenesis
• Other :
 Obstruction to venous return
 Congenital cystic adenomatoid malformation of
lung
 Impaired lymphatic drainage
 Cystic hygroma
 Karyotypic abnormalities (45XO)
 Connective tissue malformation
Fetal Infections:
TORCH
Parvo Virus B19

13. Who is affected by hydrops fetalis?
• Immune hydrops is not as common
• Non-immune hydrops occurs rarely.
• The incidence of hydrops can vary between populations

14. Why is hydrops fetalis a concern?
• About half of unborn babies with hydrops do not survive
• Risks are also high for babies born with hydrops, with
survival often depending on the cause and treatment.

15. What are the symptoms of hydrops fetalis?
• During pregnancy, symptoms may include:
large amounts of amniotic fluid
thickened placenta
ultrasound of the fetus shows enlarged liver, spleen, or
heart, and fluid buildup in the fetus' abdomen
• After birth, symptoms may include:
pale coloring
severe edema overall, especially in the baby's
abdomen
enlarged liver and spleen
respiratory distress

16. How is hydrops fetalis diagnosed?
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complete medical history and physical examination
diagnostic procedures for hydrops fetalis may include:
Ultrasound
fetal blood sampling
amniocentesis
Fetal echo
Placental thickness

17. Treatment for hydrops fetalis:
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based on:
• gestational age, overall health, and medical
history
• Extent of the disease
• Treatment of hydrops depends on the cause
• help for respiratory distress
• removal of excessive fluid from spaces
• medications to help the kidneys remove excess
fluid

18. Soft
Tissue
shadow
and
pleural
effusion
in
hydropic
neonate

20. • Thank