From the Guidelines
Hydrops fetalis is a serious fetal condition that requires immediate evaluation and management by a maternal-fetal medicine specialist, with the goal of identifying the underlying cause and providing targeted treatment to improve outcomes. The diagnosis of hydrops fetalis involves a detailed ultrasound, fetal echocardiography, and genetic testing to identify the underlying cause, which can include cardiovascular dysfunction, anemia, or other systemic issues affecting the fetus's ability to regulate fluid balance 1.
Key points for management include:
- Identifying the underlying cause through detailed ultrasound, fetal echocardiography, and genetic testing
- Treating specific causes if possible, such as intrauterine transfusion for anemia or antiarrhythmic drugs for fetal arrhythmias
- Monitoring fetal well-being closely with serial ultrasounds and non-stress tests
- Considering antenatal corticosteroids if preterm delivery is anticipated
- Planning for delivery in a tertiary care center with neonatal intensive care capabilities
Specific treatments depend on the etiology, but may include:
- For anemia: Intrauterine transfusion of packed red blood cells
- For arrhythmias: Maternal administration of digoxin, flecainide, or sotalol
- For infections: Appropriate maternal antimicrobial therapy
The prognosis varies widely depending on the cause and severity, but is generally poor without intervention, with a neonatal survival rate of often <50% 1. Early diagnosis and targeted treatment can improve outcomes in some cases, and the Society for Maternal-Fetal Medicine recommends that fetal therapy decisions be based on the underlying etiology and gestational age at which nonimmune hydrops fetalis (NIHF) develops or is first identified 1.
In cases of NIHF due to nonlethal or potentially treatable etiologies, corticosteroid therapy and antepartum surveillance are recommended, and delivery should be planned at a center with capability to stabilize and treat critically ill neonates 1. The development of mirror syndrome is an indication for delivery in most cases 1.
Overall, the management of hydrops fetalis requires a multidisciplinary approach, with close collaboration between maternal-fetal medicine specialists, neonatologists, and other healthcare professionals to provide the best possible outcomes for affected fetuses and newborns.
From the Research
Diagnosis of Hydrops Fetalis
- Hydrops fetalis is a serious condition characterized by the collection of fluid in the extravascular compartments of a fetus 2.
- The diagnosis of hydrops fetalis is often made using fetal ultrasound, which can detect signs of severe anemia and fluid accumulation in the fetus 2, 3.
- The etiology of hydrops fetalis can be immune or non-immune, with non-immune hydrops fetalis accounting for 90% of cases 2.
- The underlying causes of non-immune hydrops fetalis can include viral infections, heart disease, chromosomal abnormalities, hematological and autoimmune causes 2, 4, 5.
Management of Hydrops Fetalis
- The management of hydrops fetalis is complex and requires close coordination between obstetric and neonatal teams 6.
- Antenatal interventions, such as in-utero blood transfusions and thoracentesis, may be necessary to support the fetus 6.
- Planned caesarean deliveries and postnatal neonatal intensive care, including chest drainage and transfusions, may also be required 6.
- The goal of management is to treat the underlying cause of hydrops fetalis, whenever possible, and to support the fetus until an optimal time for delivery 2, 4.
- Early identification of the underlying causes of hydrops fetalis is essential for managing pregnancy and deciding on treatment 3, 4.
Outcomes of Hydrops Fetalis
- The prognosis for hydrops fetalis depends on the underlying cause and can be poor, with high mortality rates 2, 4, 5.
- Advances in prenatal diagnostic techniques, early detection, and individualized management have improved outcomes, but the condition remains rare and challenging to manage 4.
- Survival rates for fetuses with hydrops fetalis can be improved with timely antenatal intervention and anticipation of potential perinatal complications 6.