Diagnostic ultrasound ( PDFDrive )

CHAPTER
41
Fetal Hydrops
Deborah Levine
SUMMARY OF KEY POINTS
• Hydrops is deined as an abnormal accumulation of
interstitial luid in at least two body cavities (pleural,
peritoneal, or pericardial) or one body cavity in association
with anasarca (generalized massive edema).
Placentomegaly and polyhydramnios are common indings
in cases of hydrops but are not needed for the diagnosis.
• Hydrops represents a terminal stage for many conditions,
the vast majority of which are fetal in origin.
• The onset of hydrops signiies fetal decompensation.
• Immune causes can be successfully treated in utero, as
can an increasing number of nonimmune causes.
• Middle cerebral artery Doppler ultrasound can be used to
assess fetuses at risk for anemia.
• A team approach using obstetric imagers, maternal fetal
medicine specialists, neonatologists, and geneticists can
help to decide which cases are suitable for therapeutic
intervention.
CHAPTER OUTLINE
SONOGRAPHIC FEATURES
Ascites
Pleural Effusions
Pericardial Effusions
Subcutaneous Edema
Placentomegaly
Polyhydramnios
ETIOLOGY
IMMUNE HYDROPS
Noninvasive Assessment of
Alloimmunization
NONIMMUNE HYDROPS
Pathophysiology
Causes and Associations
Cardiovascular Abnormalities
Neck Abnormalities
Thoracic Anomalies
Gastrointestinal Anomalies
Urinary Tract Anomalies
Lymphatic Dysplasia
Monochorionic Twins
Chromosomal Anomalies
Tumors
Anemia
Infection
Genetic Disorders
Metabolic Disorders
Skeletal Disorders
Endocrine Disorders
Drugs
Idiopathic Disorders
DIAGNOSTIC APPROACH TO
HYDROPS
History
Complete Obstetric Ultrasound
Maternal Investigations
Fetal Investigations
Performing PUBS
Fetal Transfusion
Cavity Aspiration
Postnatal Investigations
FETAL WELFARE ASSESSMENT IN
NONIMMUNE HYDROPS
OBSTETRIC PROGNOSIS
Maternal Complications (Mirror
Syndrome)
Delivery
Predelivery Aspiration Procedures
Postnatal Outcome
CONCLUSION
Hydrops fetalis is an end-stage process for a number of diferent
diseases. It is deined as an abnormal accumulation of
interstitial luid in at least two body cavities (pleural, peritoneal,
or pericardial) or one body cavity in association with anasarca
(generalized massive edema). Placentomegaly and polyhydramnios
are common indings in cases of hydrops but are not needed for
the diagnosis.
Lymphangiectasia, which is abnormal dilatation of the
lymphatic vessels, should not be mistaken for hydrops. In
the irst trimester, general body wall lymphangiectasia can
have a “space suit” appearance (Fig. 41.1) due to the luid in
the skin and/or subcutaneous tissues. he inding has a poor
prognosis, with 26 in 30 prospectively identiied cases in the
irst trimester having abnormal karyotype. 1 However, because
there is not typically luid in other body cavities, this is
not hydrops.
Hydrops is the late stage of many processes that lead to
redistribution of body luids among the intravascular and
interstitial compartments. his imbalance of luid can have many
causes (Table 41.1). here are at more than 150 diferent causes
of fetal hydrops. Many of the causes and associations with hydrops
overlap. he basic etiology of hydrops is an imbalance of interstitial
luid, which may be caused by myocardial failure, high-output
cardiac failure, decreased colloid oncotic plasma pressure
(anemia), increased capillary permeability, and/or obstruction
of venous and lymphatic low.
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