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The secret weapon for discovering fetal hydrops: How does ultrasound reveal the condition?
Hydrops fetalis is swelling of the fetus in utero due to fluid accumulation in at least two fetal compartments. Divided into two types, immune and non-immune, ultrasound is the main dependent tool for behavioral detection and diagnosis. How does this secret weapon play such a huge role in ensuring the health of the fetus?
Signs and symptoms of hydrops fetalis
The manifestations of fetal edema include:
- Subcutaneous tissue of the scalp
- Fluid in the pleural cavity (pleural effusion)
- Fluid in the pericardial cavity (pericardial effusion)
- Abdominal fluid (ascites)
Fetal hydrops usually develops in the subcutaneous tissue and severe cases may lead to spontaneous abortion. This is a type of prenatal heart failure in which the heart is unable to keep up with the abnormally high demands for blood flow.
Causes of edema
There are many causes of fetal hydrops, usually factors affecting the fetus can cause anemia, which in turn requires the heart to pump more blood to provide enough oxygen.
"Edema usually results from fetal anemia, when the heart needs to pump large amounts of blood to meet oxygen supply needs."
Non-immune fetal hydrops may also occur independently of other medical conditions, such as fetal tumors or congenital pulmonary malformations, which can cause a dramatic increase in the heart's blood demand, ultimately leading to heart failure and corresponding hydrops.
Immunopathophysiology
The only immune cause of hydrops fetalis is Erythroblastosis fetalis, also known as Rh disease. When there is an Rh blood type incompatibility between the mother and the fetus, the mother's immune system may regard the fetus's red blood cells as foreign substances and produce antibodies to attack them. During the second pregnancy, this immune response caused severe anemia in the fetus and subsequent edema.
“Since preventive measures were developed in the 1970s, the incidence of Rh disease has dropped dramatically.”
Non-immune pathophysiology
Non-immune hydrops fetalis is a complex phenomenon involving many factors, including.
- Iron deficiency anemia
- Abnormal heart rhythm (such as atrial fibrillation)
- Certain inborn errors of enzymes
- Severe viral infections (e.g. B19 virus)
- Multiple fetal conditions (eg, TTTS, TAPS, TRAPS)
Diagnostic Methods
The use of ultrasound for the diagnosis and monitoring of hydrops fetalis is essential. The diagnostic criteria are:
- Excessive amount of serum-derived fluid (such as ascites, pleural effusion, or pericardial effusion) is found in at least one compartment and is accompanied by skin edema (greater than 5 mm in thickness).
- Excess serum fluid was found in both potential compartments without associated edema.
With the development of ultrasound technology, the use of MCA Doppler technology has further improved the ability to identify fetal hydrops at an early stage.
Treatment methods
Treatment options vary depending on the cause of the edema and the stage of pregnancy. For fetuses with severe anemia, blood transfusions can even be performed in the uterus to increase the chances of fetal survival.
"For edema caused by fetal anemia, internal blood transfusion or drug treatment can be considered."
Specific ways to treat fetal hydrops include:
- Medication may be needed to treat problems caused by fetal heart disease.
- For associated adenopathy or infection, fetal-maternal transfusion may be indicated.
- If the fetus has pleural effusion or large-area effusion, dialysis or installation of a drainage device should be considered.
Finally, whether it is immune or non-immune fetal hydrops, early diagnosis and appropriate treatment are crucial to improving fetal survival. Faced with this complex phenomenon, how should we take more measures to protect the health of future generations?
