nonimmune, hydrops fetalis, risk , obstetricians, postgraduates, undergraduates

1. NON IMMUINE HYDROPS
FETALIS UNIT IV
DR VARSHA DESHMUKH
KAY

2. 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

3. 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

4. Ultrasonography
KAY1. Placental Oedema 2. Scalp Oedema

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

6. 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
KAY

7. KAY

8. KAY

9. 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
KAY

10. INTRODUCTION
Potter in 1943 described clinical entity, that
affected non-Rh sensitised pregnancies,
NIH –
1) Fetal ansarca.
2) Placental oedema
3) Fetal serous effusions
NIH does not represent a specific
disease. “Late manifestation of many
severe diseases”. KAY

11. ETIOLOGY
• Cardiovascular anomalies -
tachyarrhythmia, Anatomic defects
• Chromosomal - Down syndrome, Turner
Syndrome.
• Malformation syndrome
• Twin pregnancy- Twin transfusion
syndrome
• Hematologic - Arteriovenous shunt
• Genitourinary - Congenital nephrosis
KAY

12. 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

13. DIAGNOSIS
• Ultrasound evaluation.
• Skin thickness more than 5 mm.
• Placental thickness more than 4 cm
• Ascitis, pericardial effusion, pleural
effusion.
• Polyhydramnios. KAY

14. MANAGEMENT
All 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% .

15. 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.