CASE 17574 Published on 11.01.2022

Hydrops fetalis

Section

Paediatric radiology

Case Type

Clinical Cases

Authors

Sandeep Singh Awal¹, Sajal Agarwal², Tanushree Ghosh³, Sampreet Kaur Awal⁴

1. Department of Radiology, Jeevandeep Diagnostics, Jamshedpur, India

2. Department of Radiology, G.G. Hospital, M.P. Shah Medical College, Jamnagar, India

3. Department of Pediatrics, Marwari Hospitals, Guwahati, India

4. Department of Microbiology, Guru Gobind Singh Medical College & Hospital, Faridkot, Punjab, India

Patient

26 years, female

Categories

Area of Interest Foetal imaging, Paediatric ; Imaging Technique Ultrasound

Procedure Foetal imaging, Paediatric ; Special Focus Foetal imaging, Paediatric ;

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Clinical History

A 26-year-old primipara, with non-consanguineous marriage, underwent a routine ultrasound for fetal well being at her 30th week of gestation.

Imaging Findings

Ultrasound of the fetal thorax and abdomen revealed bilateral pleural effusion, ascites and generalized fetal body oedema (Fig. 1).

Sections of fetal head and neck showed significant scalp oedema (Fig. 2).

Amniotic fluid volume (AFI) was increased at 29.01 cm, suggestive of polyhydramnios (Fig. 3)

Placental thickness was increased with maximum thickness at 5.7cm, suggestive of placentomegaly (Fig. 4).

Features were compatible with fetal hydrops.

Discussion

Background

Hydrops fetalis refers to excessive accumulation of fluid in 2 or more fetal compartments. It is of 2 types, namely [1-5]:

Immune hydrops: It is caused by feto-maternal blood group incompatibility and accounts for 1/10^th of all cases of fetal hydrops.
Non-immune hydrops: It is the more common type, accounting for approximately 90% of cases. It is associated with a variety of underlying causes including chromosomal anomalies (Turner syndrome, Down syndrome, and Edward syndrome), infections such as parvovirus B19 and cytomegalovirus, cardiac causes, lymphatic causes, metabolic disorders, maternal causes like Diabetes mellitus and haematological causes.

Imaging Perspective

Hydrops fetalis is usually an incidental finding during prenatal routine ultrasonography. Imaging findings on ultrasonography include [6-8]:

Polyhydramnios or increased AFI
Placentomegaly / increased placental thickness
Increased nuchal translucency
Generalized fetal body oedema
Pleural effusion
Pericardial effusion
Ascites

Prognosis, treatment, or therapeutic options

Early diagnosis of hydrops fetalis is imperative to improve perinatal outcomes. The overall prognosis depends on the underlying aetiology.

Written informed patient consent for publication has been obtained.

Differential Diagnosis List

Hydrops fetalis

Congestive cardiac failure

Maternal diabetes

Congenital infectious diseases

Final Diagnosis

Hydrops fetalis

References

[1] Vanaparthy R, Mahdy H. Hydrops Fetalis. [Updated 2021 Sep 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563214/

[2] Has R. Non-immune hydrops fetalis in the first trimester: a review of 30 cases. Clin Exp Obstet Gynecol. 2001;28(3):187-90. Erratum in: Clin Exp Obstet Gynecol 2002;29(1):following table of contents. Recep H [corrected to Has R]. PMID: 11530871.

[3] Van Maldergem L, Jauniaux E, Fourneau C, Gillerot Y. Genetic causes of hydrops fetalis. Pediatrics. 1992 Jan;89(1):81-6. PMID: 1728027.

[4] Abrams ME, Meredith KS, Kinnard P, Clark RH. Hydrops fetalis: a retrospective review of cases reported to a large national database and identification of risk factors associated with death. Pediatrics. 2007 Jul;120(1):84-9. doi: 10.1542/peds.2006-3680. PMID: 17606565.

[5] Hartge DR, Weichert J, Gembicki M, Krapp M. Confirmation of etiology in fetal hydrops by sonographic evaluation of fluid allocation patterns. Eur J Obstet Gynecol Reprod Biol. 2015 Dec;195:128-32. doi: 10.1016/j.ejogrb.2015.09.006. Epub 2015 Oct 19. PMID: 26540593.

[6] Hata T, Yanagihara T, Matsumoto M, Hanaoka U, Maesato T, Tanaka Y, Kuno A, Akiyama M, Yamashiro C, Ohnishi Y, Tanaka H, Hayashi K, Yamada Y. Three-dimensional sonographic features of Hydrops fetalis. Gynecol Obstet Invest. 1999;48(3):172-5. doi: 10.1159/000010167. PMID: 10545740.

[7] Berger VK, Sparks TN, Jelin AC, Derderian C, Jeanty C, Gosnell K, Mackenzie T, Gonzalez JM. Non-Immune Hydrops Fetalis: Do Placentomegaly and Polyhydramnios Matter? J Ultrasound Med. 2018 May;37(5):1185-1191. doi: 10.1002/jum.14462. Epub 2017 Oct 27. PMID: 29076544; PMCID: PMC6029704.

[8] Jenderny J, Schmidt W, Hecher K, Hackelöer BJ, Kerber S, Kochhan L, Held KR. Increased nuchal translucency, hydrops fetalis or hygroma colli. A new test strategy for early fetal aneuploidy detection. Fetal Diagn Ther. 2001 Jul-Aug;16(4):211-4. doi: 10.1159/000053912. PMID: 11399881.

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