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Radiology
Nonimmune Hydrops Fetalis
Built from Obstetric Imaging
What’s inside
11 sections · 78 slides
Overview
- Scope of this topic
What hydrops fetalis is
A sonographic sign, not a diagnosis
- Definition of hydrops fetalis
- Fluid compartments counted in hydrops
- Supporting findings: polyhydramnios and placental thickening
- Immune and nonimmune hydrops
- Two branches of fetal hydrops
- Generalized fetal swelling in hydrops
- 2.5
- Factors that shift prognosis
Why the fluid collects
One shared pathophysiology behind every cause
- Common pathophysiology of hydrops
- Four proposed mechanisms of fluid accumulation
- Routes to fluid overload in the fetal tissues
- Anemia as a route to hydrops
The causes
Fourteen categories, and a large idiopathic group
- Most frequent cause categories across all gestations
- Less frequent categories and the idiopathic group
- Gestational age at onset and likely cause
- How to use the etiology reference table
- Nonimmune hydrops fetalis etiologies: share of cases
- Nonimmune hydrops fetalis etiologies: share of cases (continued)
- Nonimmune hydrops fetalis etiologies: conditions in each group
- Nonimmune hydrops fetalis etiologies: conditions in each group (continued)
- Nonimmune hydrops fetalis etiologies: conditions in each group (continued)
- Nonimmune hydrops fetalis etiologies: conditions in each group (continued)
- Nonimmune hydrops fetalis etiologies: underlying mechanism
- Nonimmune hydrops fetalis etiologies: underlying mechanism (continued)
- Nonimmune hydrops fetalis etiologies: antepartum evaluation and management
- Nonimmune hydrops fetalis etiologies: antepartum evaluation and management (continued)
- Nonimmune hydrops fetalis etiologies: antepartum evaluation and management (continued)
- Nonimmune hydrops fetalis etiologies: antepartum evaluation and management (continued)
How it presents
Often silent — until the mother starts to mirror the fetus
- Maternal clinical presentation
- Mirror syndrome
- Distinguishing Mirror syndrome from preeclampsia
- Management of Mirror syndrome
Ultrasound findings
Two of four findings make the diagnosis
- Ultrasound as the first-line test
- Abdominal ascites on ultrasound
- Fetal ascites surrounding the liver and bowel
- Pseudoascites
- Pleural effusions on ultrasound
- Bilateral pleural effusions compressing the fetal lung
- Pericardial effusions on ultrasound
- Generalized skin edema on ultrasound
- Pleural effusions, ascites and scalp edema in a hydropic fetus
- Reading the multi-panel hydrops study
- Parvovirus hydrops before and after intrauterine transfusion
- Treatable hydrops: the parvovirus sequence
- Middle cerebral artery peak systolic velocity in fetal anemia
- Fluid collections around the fetal trunk and head
Magnetic resonance imaging
A second look at masses ultrasound cannot fully characterise
- Role of magnetic resonance imaging
Finding the cause
Imaging, maternal blood, and fetal genetics
- Yield of prenatal evaluation
- Ultrasound components of the workup
- Excluding alloimmunization
- Maternal blood tests in the workup
- Parvovirus B19 particles seen by electron microscopy
- Parvovirus B19 in fetal hydrops
- Fetal genetic testing
- Additional targeted fetal tests
- Genetic counseling and family history
- Whole exome sequencing after nondiagnostic testing
- Autopsy and postmortem genetic consultation
- Workup pathway for nonimmune hydrops fetalis
- First fork in the workup pathway
- Pathway when the middle cerebral artery Doppler is abnormal
Treatment and delivery planning
Guided by the cause, the severity, and what can be reversed
- Three management categories
- Counseling before viability
- The multidisciplinary care team
- Antenatal surveillance
- Timing of delivery
- Mode of delivery
- Fetal therapies available for specific causes
Outcomes after birth
High mortality, and survival is not the whole story
- Neonatal and infant mortality
- Survival and development in a single-centre series
Summary
What to carry away from this topic
- What the referring physician needs to know
- Key points
- References
- References (continued)
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition