Fetal dropsy: what it is, symptoms, causes and treatment

Hydrops fetalis is the accumulation of fluid in two or more tissues or organs of the baby during pregnancy, such as the lungs, heart, abdomen or skin, causing skin swelling, pleural effusion, pericardial effusion or ascites.

Hydrops fetalis is normally diagnosed during prenatal ultrasound examination, and can be caused by a complication due to blood incompatibility between the mother and baby, but can also occur due to malformations in the heart or lungs, or even due to genetic causes.

This disease is very serious and difficult to treat and can lead to the death of the baby early in life or a miscarriage.

Fetal hydrops symptoms

The main signs and symptoms of hydrops fetalis are:

• Excess amniotic fluid;
• Placenta larger or thicker than normal;
• Presence of fluid in the fetal abdominal cavity, called ascites;
• Swelling of the fetal skin, especially on the head, neck, chest and abdomen;
• Pleural effusion, which can occur in one or both lungs;
• Pericardial effusion;
• Enlargement of the baby’s liver, spleen and heart;
• Fast or irregular heartbeat in the baby;
• Decreased fetal movements.

These signs and symptoms are normally observed on ultrasound examination during pregnancy.

After birth, the baby may also present pale, yellowish or bluish skin, generalized swelling, severe swelling in the belly, breathing problems, decreased muscle tone, dermatitis, facial malformations, anemia, enlarged liver or cardiomyopathy, for example.

How to confirm the diagnosis

The diagnosis of hydrops fetalis is made by the obstetrician during pregnancy, through prenatal ultrasound, normally between weeks 18 and 22 of pregnancy.

During this ultrasound, the doctor can observe an increase in amniotic fluid, greater thickness of the placenta, swelling in the fetus’ skin, and/or accumulation of fluid in the baby’s abdomen, heart, liver, spleen or lungs.

To assess the severity and cause of fetal hydrops, your doctor may order a fetal blood test, taking a sample of blood from the fetal blood vessels or umbilical cord, or perform an amniocentesis, taking a sample of amniotic fluid during pregnancy, to be analyzed in the laboratory. See how amniocentesis is performed.

Possible causes

The main causes of hydrops fetalis are:

• Blood incompatibility of mother and baby;
• Congenital malformations of the lungs or heart;
• Anemia de Fanconi;
• Genetic changes, such as Edwards syndrome, Down syndrome, Turner syndrome or alpha-thalassemia;
• Feto-fetal transfusion syndrome, in monochorionic twin gestations;
• Infections during pregnancy, such as cytomegalovirus, rubella, herpes, syphilis, toxoplasmosis and parvovirus B-19.

In addition, hydrops fetalis can also develop due to complications in women during pregnancy such as pre-eclampsia, diabetes, severe anemia, lack of proteins in the blood and mirror syndrome, which is a generalized swelling in the body of the mother and fetus. .

Hydrops fetalis can also occur naturally in an apparently healthy pregnancy, without a cause being identified.

Types of hydrops fetalis

There are two types of hydrops fetalis, which are classified according to their causes:

• Immune hydrops fetalis: occurs due to blood incompatibility between the mother and the fetus, causing the woman’s immune system to attack the baby’s red blood cells, destroying these cells. This usually occurs when the mother has a negative blood type and the fetus has a positive blood type. Understand how negative blood type can affect pregnancy;
• Non-immune hydrops fetalis: is the most common type, being caused by diseases or complications that interfere with the baby’s microcirculation and lymphatic system, causing extravasation of liquid from the blood vessels into the cells or reducing the return of lymph to the lymphatic vessels.

The type of hydrops fetalis can be identified by the obstetrician through diagnostic tests during pregnancy, or by the pediatrician after birth.

How the treatment is carried out

When the disease is discovered during pregnancy, the obstetrician may recommend the use of corticosteroid medications or medications that accelerate the baby’s development, or may recommend surgery on the fetus while still in the womb to correct problems in the heart or lungs, when these organs are affected. .

In some cases, it may be recommended to deliver the baby early, via cesarean section.

Babies who survive must be treated soon after birth, but treatment depends on how the baby was affected and the severity of the illness, which depends on the cause of the dropsy.

In cases of immune hydrops fetalis or when the cause is anemia or parvovirus infection, treatment can be done through blood transfusions, for example.

Is hydrops fetalis curable?

In cases of mild dropsy, a cure can be achieved, however, when the fetus is severely affected, there may be a miscarriage or death of the baby early in life, for example. Find out what the main warning signs are during pregnancy and how to avoid complications.

Possible complications

When the fetus presents hydrops fetalis, complications may arise that vary depending on the part of the body affected. The most serious cases arise when liquid is present in the baby’s brain, which can lead to poor development of all organs and systems.

However, dropsy can also affect only one part of the body, such as the lungs, and in this case there are only respiratory complications.

Therefore, the complications are not always the same and each case must be evaluated by the pediatrician, and tests must be carried out to prove the severity of the disease and which treatment is most appropriate.