The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
Fetal hydrops called its pathological condition in which all the cavities of the body fluid accumulates and is present generalized edema (swelling of the whole body - anasarca).
In most cases, fetal hydrops is observed for Rh-conflict pregnancy and hemolytic disease of the newborn. The prevalence of this condition is 1 case per 1000-14000 genera. Distinguish between the immune and preimmune fetal hydrops.
Causes
The primary cause of immune hydrops fetus is its hemolytic disease.
The reason that led to the development of non-immune fetal hydrops often goes unrecognized, but there are the following factors:
- fetal chromosomal abnormality (Down's syndrome, mosaicism of trisomy, Turner's syndrome, etc.);
- genetic disease: lack of glucose-6-phosphate dehydrogenase, A-thalassemia, Noonan syndrome, ahondrogenez, tanatofornaya dwarfism, Foam-shock syndrome, multiple pterygium, achondroplasia;
- malformations of the thoracic cavity (thoracic dysplasia, diaphragmatic hernia defect cystic adenomatous lung);
- urinary system malformations (congenital nephrotic syndrome, urethral defects and kidney);
- cardiovascular disease (cardiomyopathy, Congenital heart disease, anatomical defects, arterial-venous shunts)
- horioangioma placenta;
- in multiple pregnancies (feto-fetal transfusion, akardialnaya twins);
- infectious diseases of mother during pregnancy (cytomegalovirus infection, syphilis, parvovirus infection, toxoplasmosis, Coxsackie virus pancarditis);
- pregnancy complications (preeclampsia, Severe anemia, neskorregirovanny diabetes mellitus, hypoproteinemia);
- congenital metabolic disorders (mucopolysaccharidosis type 4, Gaucher's disease, deficiency of neuraminidase, Morquio disease);
- congenital brain and spinal cord tumor, urinary system and digestive tract, liver, sacrococcygeal teratoma, neuroblastoma.
Diagnostics
Diagnosis of fetal hydrops is aimed at determining the cause, he was summoned. Primarily determined by blood group and Rh factor for confirmation / exclusion of Rhesus-conflict and immune fetal hydrops.
The analysis of the history of life (infectious diseases in the past, surgery, chronic pathology), obstetric and gynecological history (presence gynecological pathologies, course and outcomes of previous pregnancies), analyzed during the present pregnancy and its complications, the total weight gain etc.
The main diagnostic method is fetal ultrasonography. By ultrasound signs include:
- placental edema ( "thick placenta");
- excess amniotic fluid (hydramnion);
- fetal dimensions overweight due to edema (particularly enlarged abdomen due to ascites dimensions compared with the dimensions of the head);
- accumulation of fluid in the cavities of all the fruit of the body (hydropericardium, ascites, hydrothorax)
- swelling of the subcutaneous fat layer in the form of a double circuit;
- swelling of the scalp, hands and feet;
- cardiomegaly (enlarged heart size);
- thickening of the bowel (wall edema);
- enlarged liver and spleen (hepatosplenomegaly)
- "Buddha posture" - bloated stomach diverting away limbs and spine;
- low physical activity in combination with other features.
After the ultrasound appointed amnio- or cordocentesis to determine fetal karyotype, obtaining fetal blood (hemoglobin estimate protein) and possibly intrauterine treatment. In order to prevent fetal infection assigned PCR putative infection.
Treatment of fetal hydrops
In identifying congenital fetal malformation incompatible with life (1-2 trimester) women offer abortion. In case of cancellation of the interrupt continue to observe the course of pregnancy and disease progression to terms that allow for prenatal (antenatal) therapy.
Treatment of fetal hydrops is to conduct cordocentesis and blood transfusion in the umbilical cord (in the case of severe anemia and reduce hematocrit 30 and below). If necessary, exchange transfusion is repeated after 2-3 weeks.
In case of twin-fetal transfusions twins held laser coagulation vessels connecting fruit. If you can not hold a prenatal treatment, assess the risk of preterm birth in relation to the antenatal fetal death and delivery is carried out in advance with a preliminary appointment drugs to accelerate maturation fetal lung. In some cases, it shows the introduction of maternal cardiac glycosides for the normalization of the fetal heart rate.
Before delivery (it usually happens planning) are preparing for the birth of a child with hydrocephalus. Delivery room should be equipped with apparatus for cardio-pulmonary resuscitation, formed resuscitation teams 2-3 2-3 resuscitators and neonatology (immediately after birth intubated and artificially ventilated lung is carried out 100% oxygen).
Immediately after birth, and resuscitation is performed pericardiocentesis (removal by puncturing the pericardium accumulated liquid), pleural puncture (removal of fluid from the pleural cavity) and laparocentesis (exhaustion of fluid from the abdominal cavity). The umbilical artery catheters for subsequent infusion of packed red blood cells or blood.
forecasts
The prognosis of adverse non-immune hydrops fetalis and percentage of survivors is 20-33%. With the development of edema in the first trimester of pregnancy, generally finishes with spontaneous abortion during the second and third trimesters of high risk antenatal fetal death.
When the immune hydrops forecast more comforting effect on prenatal and postnatal treatment is 80-90%.
Some studies in pregnancy
- Smears during pregnancy.
- Tests during pregnancy by trimester.
- Ultrasound during pregnancy.
- Urinalysis in pregnancy.
- Coagulation.
- Installing pessary.
- Glucose tolerance test.
- Homocysteine in pregnancy.
- Amniocentesis.
- Anesthesia during childbirth.
- Fetal CTG (cardiotocography)
- Cordocentesis.
- Epidural anesthesia during childbirth.