Hydrops Fetalis

What is Hydrops Fetalis ?

Hydrops Fetalis is a life-threatening disease that develops as a result of water accumulation in tissues (edema) and seen in fetuses and newborn babies in mother’s womb. The disease, which is briefly known as hydrops, has two different types:
Immune: The mother’s immune system causes the red blood cells in the fetus to suffer damage. This is a dangerous situation that causes blood group mismatch between the baby and the mother. However, immune hydrops fetalis is not spread in society due to the prevalence of Rh immunoglobulin therapy for RH (-) women.
Non-Immune: It is the most common type of the disease. It causes discomfort in the babies due to the edema in the body.
Hydrops fetalis, which threatens the life of the baby, causes the wear out and harm of the organ system of the baby with the accumulated water in the body.
Half of the babies who suffer from this disease lose their lives. On the other hand, you should know that babies born with hydrops are at very high risk. The survival rate in these babies varies depending on the treatment speed of the disease that causes hydrops fetalis. If it is not treated, hydrops is deadly for babies. In case it is diagnosed in the early stages of your pregnancy, the treatment of the disease is possible however it the death of the baby is highly possible in case the treatment will be delayed.
Death or premature birth can be prevented in case the treatment will be applied, by the doctors after a quick evaluation, to children who are diagnosed with immune hydrops. The treatment will vary depending on the factors leading to the hydrops disease and the pregnancy age.
Infant mortality in mother’s womb is around 60 to 90 percent for nonimmune hydrops disease. This rate may increase or decrease according to the cause of the disease.

What Causes Hydrops Fetalis ?

IHydrops develops when abundant water in bloodstream leaves the veins and reaches the tissues. However, apart from this, many complications and discomfort may cause hydrops fetalis disease.
Immune hydrops fetalis may develop due to the blood group diseases of the mother. In case an RH negative mother will have RH positive baby, the immune system of the mother may recognize the RH positive red blood cells of the baby as “foreigner” or “enemy”. Attacking and spoiling the red blood cells in the baby may trigger anemia. Also hydrops fetalis cause damage to the organs of the baby which cannot deal with the anemia. The tissues and organs of the baby fill with too much fluid and this bloating will prevent the heart of the baby to not function as it should be.
Non-immune hydrop fetalis develops when we do not know how to deal with the abundant fluid filled in tissues and organs. 75 to 90 percent of hydrops disease in babies are categorized in this group. However no any mechanism has been found yet in order to explain the cause of this disease. Nevertheless, some of the following diseases can be associated with the development of hydrops.
  • Severe anemia,
  • Congenital infections,
  • Heart or liver disorders,
  • Chromosome abnormalities and birth defects,
  • Liver disease.

What Are Hydrops Fetalis Symptoms ?

Different symptoms can be observed in each baby, however, the following symptoms are the most common symptoms of hydrops fetalis disease.
Hydrops fetalis symptoms noticed during the pregnancy can be listed as follows:
  • Too much amniotic fluid (Amniotic fluid is the fluid which baby swims in the womb)
  • The weakening of placenta bind (Placenta is the formation that allows the food and oxygen exchange between the mother and fetus/baby.)
  • Notice of the enlargement of liver, heart or spleen of the fetus in ultrasounds scan or notice of edema swelling surrounding the stomach, heart, and liver.
  • Shrinkage of the diaphragm due to the insufficient development of the lungs where the baby cannot breathe fully.
The post-natal hydrops fetalis symptoms are as follows:
  • The pale skin of the baby,
  • Edema in different parts of the body but especially the abdominal region,
  • Enlargement of liver and spleen,
  • Breathing difficulty, the baby may barely breathe,
The above-mentioned symptoms may be related to other diseases. This is why never make a diagnosis on your own and consult with a pediatrician for the accurate diagnosis.

How Is Hydrops Fetalis Diagnosed ?

Diagnostic stage of the hydrops fetalis will be initiated as a result of the examination ıf the patient’s medical intervention history and physical examination. The following methods can be used during this process:
Ultrasound: Blood vessels, tissues, and organs can be displayed clearly thanks to this scanning method that is carried out by using high-frequency sound waves. Ultrasound is the ideal solution in order to be able to find out if there is any problem in blood circulation and blood flow of the veins as well as check out how the internal organs of the baby function. If there is any edema in the body of the baby, diagnosis can be performed with ultrasound.
Blood Sample: Blood sample will be received from the navel cord or fetus with the help of a needle that is injected into the mother’s womb.
Amniocentesis: Amniotic fluid of the mother will be subjected to a series of tests in the laboratory and diagnosis can be performed in this way.

How Is Birth with Hydrops Fetalis ?

Doctors will decide on the birth method in case of hydrops disease however cesarean is the most common method. Intubation (external respiratory support) is provided by placing a special tube to trachea for baby to be able to breathe easily after the birth. However, placing this tube may be really challenging due to the swelling as a result of abundant fluid. High-frequency ventilation (inhalation) may also be provided for the baby to receive enough amount of oxygen. The fluid around the abdomen and the liver area can be expelled with the tubes placed in the chest area in order to help the baby to breathe easily.
There are two arteries and one vessel between the mother and naval cord. However, liquids and medicines needed for the baby can be given with intravenous route (directly through the vein). The blood pressure can be measured and the blood sample can be taken for the blood test.

How Is Hydrops Fetalis Treatment ?

Each hydrops fetalis case may require different treatment methods. Obstetricians check the following criteria while providing direction to the treatment method.
  • Pregnancy age, general health status, and medical history,
  • The severity of the disease,
  • Baby’s resistance to various drugs and therapies,
  • The condition of the disease and preference of the mother.
Hydrops fetalis treatment may vary from case to case. Hydrops can be treated during pregnancy but only in certain cases. Premature birth may be suggested by the doctors. The following treatment methods can be applied in order to control hydrops disease in newborn babies:
  • Oxygen support or mechanical breathing device may be used to prevent breathing difficulty.
  • Excess fluid that builds up in the abdominal and liver regions and leads to bloating can be disposed of with the help of a needle.
Treatment protocol in non-immune hydrop fetalis changes depending on the main factors leading to this disease. In case the cause of the disease is known, the survival chance of the baby will increase with the treatment. However, the mother should be really careful after the birth and follow the treatment well. Because babies are often very sick starting from the birth and they require an aggressive treatment.
Mothers who want to breastfeed may store their milk with the help of a breast pump. It will be possible to not waste any time in this way when the treatment of the newborn will be completed and be ready to be fed.
The baby should breathe alone without the need of any devices or breathing tubes in order to be discharged from the hospital and sent home. It is also important that the baby can be fed since weight loss will also occur as a result of the edema discharged from the body.

Hydrops fetalis

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