Hydrops Fetalis in the Stillborn: A Series from the Central Region of Thailand

Taweevisit, Mana; Thorner, Paul

doi:10.2350/09-12-0771-oa.1

Cited by 25 publications

(35 citation statements)

References 21 publications

(49 reference statements)

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“…The mean gestational ages in these 3 groups were not signiflcantly different (P = 0.19). Some of the cases with hydrops fetalis have been previously published (8).…”

Section: Resultsmentioning

confidence: 99%

Adrenal Cytomegaly is a Frequent Pathologic Finding in Hemoglobin Bart Hydrops Fetalis

2012

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Adrenocortical cytomegaly (AC) is a relatively uncommon phenomenon but tends to occur in certain situations, including specific congenital anomalies and hydrops due to maternal-fetal Rhesus incompatibility. Because the pathology in the latter condition does not differ greatly from hemoglobin (Hb) Bart hydrops fetalis, we performed a retrospective review of fetal and perinatal autopsy cases with Hb Bart to determine the prevalence of AC in that condition. Over a 10-year period (2001-2010) at King Chulalongkorn Memorial Hospital, there were 16 hydropic cases confirmed to have Hb Bart. Adrenocortical cytomegaly was found in 13 cases (81%). For comparison, we determined the occurrence of AC in cases of hydrops fetalis not due to Hb Bart (n = 33) and a heterogeneous group of congenital anomalies (n = 34). Adrenocortical cytomegaly was identified in only 1 case of Beckwith-Wiedemann syndrome and 2 cases of anencephaly. Thus, AC is a common finding in cases of Hb Bart, a finding not previously documented. Moreover, our study suggests that Hb Bart is one of the conditions most commonly associated with AC. The reasons for this are not known. The mean Hb levels for the hydrops cases with Hb Bart and those with other forms of anemia showed no significant difference (P = 0.63), nor was there any significant difference in Hb levels between cases of Hb Bart with and without AC. Nonetheless, the consistency of AC in cases of Hb Bart suggests that further study of this particular group of patients might shed light on the pathogenesis of this poorly understood pathologic finding.

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“…The mean gestational ages in these 3 groups were not signiflcantly different (P = 0.19). Some of the cases with hydrops fetalis have been previously published (8).…”

Section: Resultsmentioning

confidence: 99%

Adrenal Cytomegaly is a Frequent Pathologic Finding in Hemoglobin Bart Hydrops Fetalis

2012

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“…In a study from Thailand, 16 % of stillborn fetuses were hydrops fetalis, and the most common cause of hydrops was anemia [ 9 ]. In two other autopsy studies from Rodriguez, frequency of hydrops was 6.07 % in stillbirth cases and 7.45 % in neonatal death cases [ 220 ].…”

Section: Pathological Findingsmentioning

confidence: 99%

“…Not surprisingly, the study from Thailand [ 9 ] showed more hematological causes, as thalassemia is common in that part of the world. [ 11 , 40 -212 ] …”

Section: Causes and Mechanisms Of Fetal Hydropsmentioning

confidence: 99%

Fetal Hydrops

Nagy¹,

Malcomson²

2015

Keeling’s Fetal and Neonatal Pathology

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Hydrops fetalis, meaning "edema of the fetus," is a clinicopathological term describing an end-stage status of fetal fl uid imbalance, and the diagnostic criteria include generalized skin edema with one or more serous cavity effusions. The underlying causes include various maternal, fetal, and placental conditions. Even if the underlying forces to edema formation are the same as has been described in adults (Starling forces), the unique features of fetal physiology, including characteristics of fetal microcirculation and immaturity of the developing organs, predispose to fetal edema formation. This chapter aims to provide some insight into the underlying pathophysiological mechanisms and should help to rationalize and categories the myriad conditions that may give rise to fetal hydrops. A better understanding of the various processes at work in the generation of hydrops provides more information for parental counseling and for more targeted antepartum/perinatal treatments. The importance of postmortem examination, including ancillary investigations, cannot be emphasized enough. Recent publications highlight the usefulness of immunohistochemical assessment of lymphatic vessels in idiopathic cases. It has been also shown that, when postmortem examinations are completed along with clinical assessments, the underlying causes can be found in very high percentage of the cases (>90 %). Even if the underlying forces to edema formation are the same as has been described in adults (Starling forces), the unique features of fetal physiology, including characteristics of fetal microcirculation and immaturity of the developing organs, predispose to fetal edema formation. This chapter aims to provide some insight into the underlying pathophysiological mechanisms and should help to rationalize and categories the myriad conditions that may give rise to fetal hydrops. A better understanding of the various processes at work in the generation of hydrops provides more information

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“…Some hemo globinopathies, such as Hb Bart, result in extreme hypoxia, and such model cases are important to include when validating a grading system that reflects fetal hypoxia. We therefore took advantage of the fact that Hb Bart has a high prevalence in Thailand [15].…”

Section: Introductionmentioning

confidence: 99%

Histologic Changes in the Adrenal Gland Reflect Fetal Distress in Hydrops Fetalis

2014

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The distribution of lipid in the fetal adrenal cortex is reported to correlate with the duration of hypoxia and degree of fetal stress. The original studies were based on Oil Red O staining, requiring frozen tissue that is often not available. To investigate the reliability of these observations, the distribution of lipid in the fetal adrenal cortex was studied in hydrops fetalis (HF) of different etiologies, using immunostaining for adipophilin on formalin-fixed material. Twenty cases of HF due to hemoglobin (Hb) Bart were compared to 34 cases of HF due to other causes. In the fetal zone, lipid distribution was more diffuse in Hb Bart HF compared to other causes of HF, including those due to anemia, supporting the concept that increased lipid in the fetal zone is associated with severity of hypoxia. A more diffuse distribution of lipid correlated with adrenal cytomegaly (P < 0.01) and extramedullary hematopoiesis (P < 0.01) but not Hb level (P = 0.68) nor compact cell change (P = 0.7) or cystic degeneration (P = 0.07) in the definitive zone. A greater degree of cystic degeneration correlated with lower gestational age, rather than the specific etiology of HF. Thus, cystic degeneration is more a reflection of the onset of fetal stress than severity. The combined histologic changes in the fetal and definitive zones of the adrenal gland provide complementary information about fetal status in HF. Immnunostaining for adipophilin circumvents the need for frozen tissue for assessing lipid content by Oil Red O staining, facilitating studies based on archival material.

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Hydrops Fetalis in the Stillborn: A Series from the Central Region of Thailand

Cited by 25 publications

References 21 publications

Adrenal Cytomegaly is a Frequent Pathologic Finding in Hemoglobin Bart Hydrops Fetalis

Adrenal Cytomegaly is a Frequent Pathologic Finding in Hemoglobin Bart Hydrops Fetalis

Fetal Hydrops

Histologic Changes in the Adrenal Gland Reflect Fetal Distress in Hydrops Fetalis

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