Diagnostic ultrasound ( PDFDrive )

1436 PART IV Obstetric and Fetal Sonography
A
B
C
FIG. 41.30 Drainage of Ascites in Fetus at 26 Weeks With
Lymphatic Duct Dysplasia. (A) Transverse view of fetal abdomen
shows ascites with omentum (arrows) outlined by ascitic luid. (B)
and (C) Images during draining procedure show the needle in the
amniotic luid (B) and ascitic luid (C).
Maternal Complications (Mirror Syndrome)
Maternal complications may occur in association with fetal
hydrops. Hypoproteinemia, edema, weight gain, hypertension,
oliguria, and preeclampsia may develop. 215 his association has
been termed mirror syndrome because edema in the pregnant
patient mirrors that of the hydropic fetus. 34,216,217 he syndrome
has been described in conjunction with hydrops of various
causes. 215,218,219 Perinatal mortality and morbidity rates are high.
Maternal outcome can be improved by delivery of the fetus and
placenta or by fetal intervention to treat the cause of the
hydrops. 217,220-222 If hydrops cannot be cured, delivery may limit
the risk of maternal complications. 35,222
Espinoza et al. 223 recently suggested the high plasma concentrations
of soluble vascular endothelial growth factor receptor 1
(sVEGFR-1) is implicated in the pathophysiology of mirror
syndrome. Hypoxia of the villous trophoblast in cases of villous
edema leads to increased production and release of sVEGFR-1
and other antiangiogenic factors into the maternal circulation.
Excessive concentrations of these products may be responsible
for maternal edema in mirror syndrome.
Delivery
Mode and location of delivery are based on obstetric factors,
taking into account the underlying prognosis. 224 Uterine overdistention
in severe polyhydramnios carries the risks of placental
abruption and cord prolapse ater membrane rupture and
postpartum hemorrhage from uterine atony. Prematurity secondary
to polyhydramnios is a major contributing factor to the poor
outcome of some neonates. herapeutic amniocentesis before
induction of labor may be considered in cases with massive
polyhydramnios to decrease the risk of malpresentation or cord
prolapse. Indomethacin has also been used to decrease the
amniotic luid volume. 225 his drug should be used with caution
ater 32 weeks’ gestation because of the potential for ductal
constriction.