MyPACS.net: Radiology Teaching Files > Case 26178983

previously visited HYDROPS FETALIS
Contributed by: Natalie Giuffre, Triton College, River Grove, IL, USA, Illinois, USA.
Patient: 32 year old female
History: Patient History:
32 year old female
Blood type - O+ antibody screen came back negative
Maternal- negative hypertension, diabetes, asthma, alcohol use, drug use, cigarette use
Negative family history of birth defects

Past OB History:
G3 P2
First pregnancy delivered via C-section (2003) 40 wks no complications
Second pregnancy delivered via C-section (2005) 39 wks no complications

Ultrasound History:
2 studies have been done on this patient. The first was done on 8/27/07 with no priors and the second was done on 10/23/07.
Images:[small]larger

Fig. 1: This image is demonstrating the enlargement of the placenta.

Fig. 2

Fig. 3: The purpose of this image is to show the femur length as well as the edema surrounding the upper portion of the thigh.

Fig. 4: This image is demonstrating scalp edema as well as the head circumference.

Fig. 5: This image demonstrates the measurement of edema within the fetal tissue surrounding the chest as well as pericardial and pleural effusion.

Fig. 6: Head of the fetus
Findings: Ultrasound findings in the first study:

There is a single live intrauterine pregnancy presenting in cephalic presentation. Placenta is posterior demonstrating no signs of previa. Amniotic fluid index measures 11.54 cm which is normal at this gestational age. There is presence of a normal 3 vessel cord with normal insertion into the abdomen. The cranium and the spine are intact without visible defect. The lateral ventricle measures 6.5 mm which is WNL; there is no evidence of ventriculomegaly. The cisterna magna and cavum septum pellucidum are identified and WNL. The nuchal fold measures 3.9 mm. The heart has 4 chambers and a normal rate of 150 beats per minute. Visualization of the left sided fetal stomach, 2 kidneys, and the fetal bladder were confirmed.
Fetal Biometry was as follows:
BPD- 4.45 cm
HC- 17.00 cm
AC- 14.80 cm
FL- 2.93 cm

The gestational age based on these measurements is 19 wks 4 days
The patient was told to come back for a follow up of the lateral ventricles as the choroid plexus did not completely fill the ventricles.

Ultrasound Findings in the Second Study:

There is a single live fetus in cephalic presentation. The placenta is posterior/fundal and demonstrating no signs of previa. Amniotic fluid is borderline increased measuring 21 cm. The S/D Ratio of the umbilical artery is 23.0, the resistive index is 1.0. THe structural survey is markedly abnormal. There is diffuse skin thickening - 1-1.5 cm at its greatest. There is bilateral pleural effusion accompanied by moderate to large ascites. The cranium and sine are intact without any focal defect. The lateral ventricle measures 0.9 cm which is WNL. There is no evidence of ventriculomegaly but the choroid plexus has not changed given that it does not completely fill the ventricles. The cisterna magna is normal in size. The heart has a regular rythem with 122 beats per minute. Two paraspinal kidneys are confirmed with one of the kidneys mildly dilated measuring 5 mm in diameter. The bladder is confirmed. THe left sided fetal stomach is not seen.
Fetal Biometry was as follows:

BPD- 7.4
HC- 25.8
AC- 33.1
FL- 4.7
All measured ratios and indices are abnormal
THe current expected gestational age is 27 wks 5 days
Based on todays measurements, the composite gestational age is 30 weeks 1 day
Diagnosis: Non-immune Hydrops Fetalis (NIH)
Discussion:

Hydrops fetalis is a condition in which excessive fluid accumulates within the fetal body cavities. There are two types of hydrops: immune hydrops and non-immune hyrdrops. Immune hydrops relates to the presence of the IgG antibody (serum immunoglobin G) in the maternal serum that fights against one of the fetal blood cell antigens. This process is called sensitization. Immune hydrops is diagnosed on routine antenatal laboratory evaluation that tests for a variety of antibodies. This can happen any time a mother is subjected to red blood cell antigens that are different from her own. For example, if a father is Rh+ and the mother is Rh- the bloods will mix and antibodies can be produced that fight against the Rh antigen. The antibodies created from the bloods mixing can pass through the placenta and cause the fetal blood cells to be destroyed, resulting in anemia. Generally speaking, Immune hydrops is due to blood group incompatibility. Immune hydrops is rare and can be avoided if RhoGAM is given. There are multiple fetal, maternal, and placental disorders where maternal and fetal bloods will be mixing. Non-immune hydrops (NIH) is said to cause or is associated with disorders including:cardiovascular, chromosomal, hematologic, urinary, pulmonary problems, twin pregnancies, malformation syndromes, and infectious diseases specifically- toxoplasmosis, rubella, cytomegalovirus, herpes type 1, syphilis, congenital hepatitis, and parvovirus B19. The cause of non-immune hydrops is idiopathic. However, it is known that cardiovascular lesions are the most common cause of NIH. Severe anemia is the second well-recognized cause. To diagnose non-immune hydrops isoimmunization is ruled out with an antibody screen. By sonographic evaluation, both types of hydrops fetalis are characterized by extensive accumulation of fluids not only in the fetal tissues but the fetal body cavities as well.

Characteristics/Ultrasound Findings with Fetal Hydops are but not limited to: fetal edema (anasarca), placenta enlargement, polyhydramnious, ascites, pleural effusion, and pericardial effusion

Incidence:

Immune Hydrops- rare

Non-immune Hydrops- 1 in 2500 to 1 in 3500 pregnancies

Survival Rate:

Poor. Overall survival rate is about to 1/3 of those affected

References:

Hagen-Ansert, Sandra L. Textbook of Diagnostic Ultrasonography. 6th Edition. Volume 2. Pages 1086-1093.

Mosby Elsevier. St. Louis, MO. 2006

Henningsen, Charlotte. Clinical Guide to Ultrasonography. Pages 267, 270.

Mosby Elsevier. St. Louis, MO. 2004

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Additional Details:

Case Number: 26178983Last Updated: 05-04-2009
Anatomy: Other   Pathology: Other
Modality: USAccess Level: Readable by all users

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