In the name of God
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Transcript of In the name of God
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In the name of GodIn the name of God
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Hydrops Fetalis
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Hydrops = Generalized subcutaneous edema in the fetus or neonate
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Definition :
1. Excess serous fluid in at least one space
(ascites, pleural effusion, or pericardial
effusion) + skin edema (> 5 mm thick)
2. Excess fluid in two spaces without edema
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Hydrops Fetalis
Non Immune Hydrops Fetalis (90%)
Immune Hydrops Fetalis (10%)
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1. Anemia
2. Cardiac failure
3. Fetal Hypoxemia
Pathogenesis
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Pathogenesis (cont).
4. Extra vascular protein leakage →
increased capillary permeability →
hypoalbuminemia → Accumulation
of fluid in body cavities
5. Placental perfusion abnormalities
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Etiology
1. Hematologic: Due to anemia (10% of cases) :
A. Isoimmune hemolytic disease (RH incompatibility).
B. Hemozygous alphathalassemia
C. Hemozygous G6PD d,
D. Feto maternal hemorrhage - twin - to twin transfusion
E. Bone marrow failure - bone marrow replacement -
leukemia
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In RH incompatibility :
• Fetus is RH + / mother is RH –
• Maternal exposure to foreign antigens → IgG
antibodies fetal antigens → destruction of fetal
RBCs → Hemolysis hydrops
fetal anemia → reticulocytosis (Hb<7 g/dL)
→ erythroblastosis.
Against
In severe form
In severe form
In moderate form
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2. Cardiovascular: Due to heart failure (20% cases)
A. Rhythm disturbances
B. Major cardiac disease
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3. Renal (5% of cases)
Nephrosis, RVT, urinary obstruction
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4.Infection (8% of cases)
TORCH-Syphilis-Congenital Hepatitis,
Parvovirus….
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5. Pulmonary (5% of cases)
Chylothorax, diaphragmatic hernia ,
intrathoracic mass
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6. Placental or cord (rare)
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7. Maternal conditions (5% of cases) :
Toxemia, diabetes, thyrotoxicosis
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8. Gastrointestinal (5% of cases) :
Meconium peritonitis …..
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9. Chromosomal (5% of cases) :
Turner syndrome, trisomy 13,18,21
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10. Miscellaneous (10% of cases) :
Cystic hygroma, wilms’ tumor –
teratoma - Neuroblastom
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11. Unknown (20% of cases) :
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Signs of hydrops :
1. Pericardial & pleural effusions
2. Ascites
3. Skin edema
4. Hepatosplenomegaly
5. Polyhydramnios
6. Placental thickening
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Diagnosis :
• Pregnant woman with :
• Polyhydramnios, severe anemia, toxemia, isoimmune
disease → ultrasonic examination → Fluid
accumulation in the fetus or placenta
of circulating maternal antibody → NIHF
In the absence
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Post natal Evaluation
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