Fetal anasarca, ascites, pericardial & plueral effusion

Immune Hydrops - initiated by maternal serum IgG to fetal RBC
    sensitization occurs during previous fetal blood exposure
    Rh (D) antigen causes 55%, 15% of whites neg, 8% of black
    Before Rhogam it caused 98%, now more ABO & atypical antig
    Hemolytic Anemia - caused by IgG crossing the placenta
        relation between Hct & severity of hydrops not constant
    Survival improves if no hydrops develops, esp post transfusion
    Extramedullary Hematopoiesis - replaces normal spleen & liver
        Hepatospleenomegaly - early sign, Portal Venous Hypertension associated
        Umbilical venous htn causes palcental edema, >4cm abn
        normal hepatic proteinn production impaired
        isolated severe hypoprotienemia not always assoc w hydrops
        Cardiac Output increases due to anemia
        Hypoxia & Acidosis occur, capillary dilatation and increased permeability
    Anasarca - Generalized skin thickening >5mm, late manifest
    Polyhydramnios - freq and early finding
    Indirect Coombs Test - demonstrates presence of IgG Ab to RBC
    Tx - Rhogam, Rh (D) immunoglobulin removes any fetal antigen
        prevents recognition & IgG production
        Amniocentesis if mother IgG pos
        Bilirubin level infered by determining optical density
        Severity level 1-3, Some obtain Hct for level 3
        use cordocentesis, 2% mortality & inc sensitization
    US Follow-up practical if no effusion or skin edema evident
    cordocentesis needed if level 3 & US evidence shown
    Intrauterine transfusion may become necessary
    Debate - deliver fetus when lung mature or at term?
        term fetus better equiped to metabolize bilirubin

Nonimmune Hydrops Fetalis - Same Symptoms, no IgG, neg Coombs Test
    Late manifestation of multiple severe diseases
    50% are cardiac arrythmia & structural anomalies
    14% chromosomal: triploidy, tri 18, 21 & Turners
    Maternal Diabetes Mellitis & a-Thalasemia
    30% uneventful during gest, No lab screens, US detects 100%
    Polyhydramnios 75%, most common finding & reason for eval
    Pulmonary hypoplasia freq results from plueral effusions
    Placental thickening w anemia & cardiac anomalies, >4cm
    Skin thickening >5mm more common when anemia NOT present
    Cystic Hygroma - localized skin thickening, post neck
        seen in 1/3 w nonimmune hydrops, abn lymphatic dev
    Generalized Congenital lymphangictasia - always fatal
        Prognosis - 50% overall, Arrythmia is most treatable cause near 100% fatal when assoc with structural anomaly

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