Dayton Children’s Hospital

Hydrops Fetalis

What is hydrops fetalis?

Hydrops fetalis is a condition in which a fetus or newborn has an abnormal amount of fluid buildup in the tissue surrounding the lungs (pleural space), the tissue surrounding the heart (pericardial sac), the abdomen (a condition known as ascites), as well as under the skin (a condition known as edema).

There are two types of hydrops fetalis: Nonimmune and Immune

Nonimmune hydrops fetalis: This is the most common type of hydrops fetalis. This type occurs when the baby has a disease or medical condition that disrupts the body’s ability to manage fluids. The main causes of nonimmune hydrops fetalis are heart or lung problems, severe anemia or genetic or developmental problems.

Immune hydrops fetalis: This type is a complication of Rh incompatibility, a condition in which the immune system of a mother with Rh negative blood attacks her baby’s Rh positive blood cells. Rh incompatibility destroys a large number of the baby’s red blood cells, which causes swelling in the entire body. Rh negative mothers receive RhoGAM to prevent this complication from developing.

How is hydrops fetalis diagnosed?

Hydrops fetalis is often diagnosed during an ultrasound during pregnancy. The ultrasound may show amounts of amniotic fluid that are higher than normal, an abnormally large placenta and/or swelling in the baby’s organs (e.g., the liver, heart or lungs).

In other cases, hydrops fetalis is not diagnosed until after the baby is born and begins to show symptoms. Common symptoms of hydrops fetalis include breathing problems, anemia, jaundice (yellowing of the skin and eyes), pale skin, bruising, and swelling in the entire body.

If your doctor suspects that your baby may have hydrops fetalis, either before or after birth, tests may be done to confirm the diagnosis. Common tests for diagnosing hydrops fetalis include maternal medical history, maternal blood test to check blood type and look for the presence of antibodies, amniocentesis, or an ultrasound of the fetus’ heart.

How is hydrops fetalis treated?

How your baby’s hydrops fetalis is treated will depend on the cause. For immune hydrops fetalis, fetal blood transfusions may be necessary to help improve the condition. The causes of non-immune hydrops are so numerous that treatment depends on the specific problem that is causing hydrops. Occasionally, there is no treatment and the baby must be delivered.

Treatments for newborns may include blood transfusions, drainage of fluid from the chest and abdomen to help breathing, neonatal intensive care, medications and/or surgery to treat the underlying cause.

In many cases the ultimate cause of hydrops fetalis cannot be identified. Supportive care can be provided in the neonatal intensive care unit while awaiting improvement of the infant.

 

How will hydrops fetalis affect my baby during and after surgery?

Whether or not your baby will need surgery will depend on the cause of the hydrops fetalis. In some cases, surgery may be needed to repair the heart or lungs or to repair any developmental defects. Once the reason for hydrops fetalis has been identified, your infant’s doctors will discuss treatment options with you.