High-Risk Newborn

Hydrops Fetalis

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. There are two types of hydrops:

• immune - results when the mother's immune system causes breakdown of red blood cells in the fetus. This is the most dangerous problem of blood group incompatibility between the mother and baby.
  
  
• non-immune - the most common type; can result when diseases or complications interfere with the baby's ability to manage fluid.

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 may develop because of Rh disease in the mother. When an Rh negative mother has an Rh positive baby, the mother's immune system sees the baby's Rh positive red blood cells as "foreign." When the mother's antibodies attack the foreign red blood cells, they are broken down and destroyed, resulting in anemia. 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.
  
  
• Non-immune hydrops 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:
  
  
  • severe anemias
  • congenital infections (infections present at birth)
  • heart or lung defects
  • chromosomal abnormalities and birth defects
  • liver disease

Who is affected by hydrops fetalis?

Immune hydrops is not as common as it used to be since the widespread use of Rh immunoglobulin treatment for Rh negative women. Non-immune hydrops occurs rarely. Premature babies with hydrops are at increased risk. The incidence of hydrops can vary between populations.

Why is hydrops fetalis a concern?

The severe edema that occurs with hydrops can overtake the baby's organ systems. 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.

What are the symptoms of hydrops fetalis?

The following are the most common symptoms of hydrops fetalis. However, each baby may experience symptoms differently.

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 (difficulty breathing)

The symptoms of hydrops fetalis may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.

How is hydrops fetalis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for hydrops fetalis may include:

• ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
  
  
• fetal blood sampling - done by placing a needle through the mother's uterus and into a blood vessel of the fetus or the umbilical cord.
  
  
• amniocentesis - withdrawing some of the amniotic fluid for testing.

Treatment for hydrops fetalis:

Specific treatment for hydrops fetalis will be determined by your baby's physician based on:

• your baby's gestational age, overall health, and medical history
• extent of the disease
• your baby's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment of hydrops depends on the cause. During pregnancy, hydrops may be treatable only in certain situations. Management of hydrops in newborn babies may include:

• help for respiratory distress using supplemental oxygen or a mechanical breathing machine
  
  
• removal of excessive fluid from spaces around the lungs and abdomen using a needle
  
  
• medications to help the kidneys remove excess fluid