Fetal hydrops

Complicates 1 in 3000 pregnancies.

Diagnosis requires presence of fluid collections in two or more intrauterine locations including pleural effusion, ascites, pericardial effusion, subcutaneous edema, and polyhydramnios.

Two major causes: alloimmune hemolytic anemia and nonimmune hydrops fetalis.

Since the introduction of anti-D immune globulin treatment, more than 90% of cases are nonimmune.

Non-immune hydrops fetalis (NIHF) is defined as the presence of pathologic fluid accumulation and at least two fetal sites: including the serous cavities of the pericardium, pleura, and peritoneum, with associated skin edema.
Nuchal  translucency and cystic hygroma during the first trimester have been added to diagnostic criteria.
Perinatal mortality is high among fetuses that have nuchal translucency exceeding 5 mm, cystic hygroma and suspected lymphatic related hydrops fetalis in the first trimester.
These features are associated with a poor outcome and a genetic underlying pathology.
Genetic testing of exome  sequencing revealed lfetal structural anomalies in 9-24% of fetuses with NIHF.
Non-immune hydrops fetalis  Diagnosis established by ruling out maternal red cell allo immunization.

NIHF occurs in up to one in 1700 fetuses it has multiple causes, which include: Chromosomal abnormality‘s, structural malformations especially of heart and chest, inborn errors of metabolism, and in utero infections.

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