Non‐immunological Hydrops Fetalis

Abstract

Summary In a consecutive series of 182 cases of hydrops fetalis 33 (17·6 per cent) were due to causes other than blood group incompatibility, the incidence of non‐immunological hydrops fetalis being 1 in 3538 deliveries. Of the 33 cases, 13 were idiopathic, 6 were associated with twin pregnancies, 7 had major malformations and the remaining 7 had a variety of associated diseases. The high incidence of polyhydramnios, pre‐eclampsia and prematurity in cases of idiopathic hydrops was confirmed, and the series included one case of eclampsia. The subsequent obstetric performance of these patients was very different to what occurs with rhesus immunization and 21 of 22 further pregnancies were uncomplicated, the other resulting in a surviving hydropic infant. There is an association (3 of 13 cases) between severe maternal anaemia and idiopathic hydrops. This association is more significant than that between hydrops fetalis and any fetal malformation other than adenomatoid hamartoma of the lung. No relationship between diabetes and of fetal hydrops was found. Urinary oestriol excretion was low in two cases of idiopathic hydrops in which this test was performed indicating that hydrops probably represents chronic feto‐placental dysfunction rather than an acute episode of circulatory failure. In non‐immunological hydrops the placental weights are of the same order as those seen in erythroblastosis. Fetal anaemia was not found in any case nor were fetal plasma protein levels consistently low. In the twin transfusion syndrome the exsanguinated twin can become hydropic and both twins may be affected. It is concluded that hydrops is unlikely to have a single aetiology and that the pathogenesis cannot be explained by such simple considerations as fetal anaemia.

Nonimmune Hydrops fetalis: Fetal and Neonatal Outcome during 1983–1992

“…In 1970, Macafee et al [19] reported a 58% stillbirth rate in 33 NIHF cases. The median gestational age at stillbirth in their study was 32 (range weeks.…”

Idiopathic hydrops fetalis report of 4 patients including 2 affected sibs

“…During the last decade there have been additional reports which have emphasized a wide variety of associated fetal and maternal conditions that may or may not be related to NIHF [2,3,6]. From the reported incidence of such hydrops in Caucasian populations, approximately 20% appear to be nonimmunologic [2,7].…”

How do we counsel patients carrying a fetus with pleural effusions?

“…Since an important part of fetal lung development is known to take place during the second trimester of pregnancy, relieving intrathoracic pressure may be most crucial at that time so as to allow proper lung growth and to avoid pulmonary hypoplasia. In addition, relieving intrathoracic pressure will avoid heart compression and will maintain normal position of the mediastinum which should allow normal venous return to the heart and avoid hemodynamic alterations which could lead to further fetal pleural effusions and generalized hydrops [20][21][22][23] . If the pleural effusion occurs late in pregnancy, death after delivery could occur due to respiratory failure resulting from the pulmonary compression caused by the effusion.…”