Hydrops Fetalis: Causes, Diagnosis, and Treatment Approaches

Hydrops fetalis is a severe, life-threatening condition marked by the abnormal accumulation of fluid in at least two fetal compartments, such as the skin, lungs, heart, or abdomen. This condition can be classified into two types: immune and non-immune hydrops fetalis, each with distinct causes and treatment approaches.

Immune hydrops fetalis is primarily caused by Rh incompatibility, where the mother’s immune system attacks the fetus’s red blood cells. This leads to severe anemia, causing fluid buildup in various fetal compartments. Historically, immune hydrops fetalis was a leading cause of fetal morbidity and mortality, but the introduction of Rh immunoglobulin (RhoGAM) has drastically reduced its incidence by preventing maternal sensitization and the subsequent immune response. RhoGAM is given during pregnancy to Rh-negative mothers, preventing the formation of antibodies against Rh-positive fetal blood cells.

Non-immune hydrops fetalis, which has become the more common form due to medical advancements in preventing immune-related cases, arises from a wide range of underlying conditions that affect the fetus’s ability to manage fluid. These include severe anemias like alpha-thalassemia, heart and lung defects such as congenital diaphragmatic hernia, genetic and metabolic disorders, and viral infections like parvovirus B19 and cytomegalovirus. In some cases, the exact cause remains elusive. Recent studies have also pointed to the increasing role of maternal diabetes and obesity as potential risk factors contributing to non-immune hydrops.

Diagnosis is typically confirmed through ultrasound, which allows for the detection of fluid buildup and other fetal abnormalities. Further investigations, including amniocentesis or fetal blood sampling, may be necessary to pinpoint the underlying cause. Treatment strategies vary based on the root cause and may include interventions like early delivery, intrauterine blood transfusions, or medications to manage heart failure or infections. Despite advances in prenatal care, hydrops fetalis remains a condition with a high mortality rate, particularly when diagnosed late, underscoring the importance of early detection, thorough monitoring, and appropriate management.
Hydrops Fetalis: Causes, Diagnosis, and Treatment Approaches