|Year : 2016 | Volume
| Issue : 1 | Page : 177-178
Hydrops fetalis: our experience in a rural setting
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
|Date of Submission||12-Mar-2014|
|Date of Acceptance||20-May-2014|
|Date of Web Publication||18-Mar-2016|
FMC Paed, Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University Kano, 700001 Kano
Source of Support: None, Conflict of Interest: None
The presence of two or more of the following: ascites, pleural fluid, pericardial fluid, or generalized edema, defines hydrops fetalis. It occurs worldwide, but there is limited information on its incidence in Nigeria. It may follow massive intrauterine destruction of the fetal red blood cells, resulting in severe fetal anemia and subsequently anemic heart failure. This occurs in those with immune-mediated hemolysis; other notable causes are fetal arrhythmias, respiratory disorders, and inborn errors of metabolism. Early detection of at-risk pregnancy is the key to a successful outcome; hence, the importance of antenatal care cannot be overemphasized. Therefore, the case of an hour-old male newborn who presented with generalized edema, ascites, and central cyanosis is reported here. He had a normal packed cell volume and was diagnosed with nonimmune hydrops fetalis; however, the patient died 30 min later, and although an autopsy was not performed, the clinical features were suggestive of a cardiovascular cause.
Keywords: Ascites, cyanosis, edema, nonimmune hydrops fetalis
|How to cite this article:|
Aliyu I. Hydrops fetalis: our experience in a rural setting. Menoufia Med J 2016;29:177-8
| Introduction|| |
Hydrops fetalis is the accumulation of fluid in two or more body compartments such as the subcutaneous space, ascites, pleural, or pericardial effusion . It occurs worldwide, with varied reported incidences. In the USA, it is reported to occur in one in 600 to one in 4000 pregnancies, whereas in the Asian subcontinent, it occurs in one in 500 to one in 1500 pregnancies ; however, its actual incidence in Nigeria is not completely known, but it is present in 28.6% of cases of congenital malformation diagnosed ultrasonographically over a 5-year period in a Nigerian tertiary hospital , and few case reports have been documented in the southern part ,. The clinical presentation depends on the underlying cause; however, a high index of suspicion should be considered in at-risk pregnancy, with early referral to centers with facilities to manage such cases. Hydrops fetalis is a nonspecific clinical entity; common causes include severe fetal anemia, cardiac arrhythmias, and chromosomal disorders, and it may be idiopathic in 17.8% of cases . Treatment depends on its cause; procedures such as fetal transfusion, maternal digoxin therapy, and fetal thoracocentesis/abdominal paracentesis may be instituted.
| Case report|| |
An hour-old neonate delivered at term to a para 5, 4 alive mother, presented with bluish discoloration of the limbs and lips at birth with generalized body swelling. Pregnancy was not adversely eventful, but the mother did not receive antenatal care. There was no history suggestive of an increased/reduced amniotic fluid at delivery or placenta edema. The child was observed to be cyanosed at presentation, in respiratory distress, and he had no dysmorphic features with generalized edema and ascites [Figure 1]. The chest examination showed tachypnea but no crepitations; he was also tachycardic with first and second heart sounds, but no murmur. Oxygen saturation in room air was 70%, which did not improve significantly (75%) despite 100% oxygen administration, and the packed cell volume was 56%. The random blood sugar was normal, but chest radiograph, ECG, and echocardiography could not be performed. He was resuscitated, but he died 30 min later. An autopsy was not performed. The diagnosis of cyanotic congenital heart disease was, however, considered.
|Figure 1: Generalized edema, abdominal swelling, and generalized bluish discoloration.|
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Consent was obtained from the caregiver for using the patient's information and picture.
| Discussion|| |
Hydrops fetalis is the endpoint of several disease processes. With the advent of immunoglobulin D, the incidence of rhesus isoimmunization as a cause has decreased markedly. Bellini et al. , in their review of 225 nonimmune hydrops fetalis articles, established 14 different diagnostic categories. They were classified into the following diagnostic categories: cardiovascular (21.7%), hematologic (10.4%), chromosomal (13.4%), syndromic (4.4%), lymphatic dysplasia (5.7%), inborn errors of metabolism (1.1%), infections (6.7%), thoracic (6%), urinary tract malformations (2.3%), extrathoracic tumors (0.7%), placental (5.6%), gastrointestinal (0.5%), miscellaneous (3.7%), and idiopathic (17.8%) . This case did not survive to benefit from a thorough investigation to determine the etiology, but the fact that the child was cyanosed excluded a diagnosis of immune hydrops fetalis, and the documented tachycardia and failure of resolution of cyanosis with poor appreciation of the oxygen saturation despite oxygen therapy points toward a possible primary cardiovascular etiology.
This case highlights the importance of antenatal care because early ultrasound could have aided the diagnosis and proper measures could have been instituted.
| Conclusion|| |
A case of nonimmune hydrops fetalis has been reported and antenatal services are invaluable if the goal of improving maternal-newborn survival is to be achieved.
| Acknowledgements|| |
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bellini C, Hennekam RCM. Non-immune hydrops fetalis: a short review of etiology and pathophysiology. Am J Med Genet 2012; 158
Akande HJ, Inikori AK, Braimoh KT, Jimoh AAG, Nzeh DA. Fetal congenital anomalies diagnosed by ultrasonography at Ilorin, Nigeria: a five-year review. Available at: . [Accessed 6 August 2013]
Mbarie LA, Fasoranti IO, Omoigberale AI Hydrops fetalis: a case report. Niger Hosp Pract 2009; 3
Abdulkadir AY, Adesiyun OA, Fawole AA, Aboyeji AP. Congenital gastric outlet obstruction and nonimmune hydrops fetalis: a prenatal sonographic diagnosis of a case with hydrothorax and ascites. Sci World J 2008; 8
Bellini C, Hennekam RCM, Fulcheri E, Rutigliani M, Morcaldi G, Boccardo F. Etiology of nonimmune hydrops fetalis: a systematic review. Am J Med Genet A 2009; 149A