ABSTRACT
PURPOSE: To understand the pathophysiology of nonimmune hydrops fetalis, retrospective study was achieved. We evaluated cardiac anomalies and heart functions of newborns with nonimmune hydrops fetalis admitted to our neonatal intensive care unit. METHODS: A retrospective study was conducted on the newborn diagnosed as nonimmune hydrops fetalis (NIHF) between January 1995 and December 2005. To analyze cardiac structures and heart functions of the study population, echocardiographic data were used that carried out within 2 days after birth. RESULTS: During the study period, 29 newborns (18 males and 11 females; mean birth weight 2,877 g; mean gestational age 34.4 weeks) were identified as NIHF. There were 15 cases of structural cardiac anomaly, 5 cases of cardiomegaly, 2 cases of arrhythmia and one case of pericardial effusion. Among those patent ductus arteriosus were observed in 12 cases and there were 10 cases of patent foramen ovale (PFO) or atrial septal defect. Ebstein's anomaly with PFO and atrioventricular septal defect was one case respectively. Most cases appeared hypoalbuminemia and anemia. Difference of heart functions between neonatal survival group and neonatal death group had no statistical significance. CONCLUSION: Because there was no significant difference in cardiac function between neonatal survival group and neonatal death group, simple decline of the heart function is not sufficient for the explanation of pathophysiologic mechanisms. Nevertheless, NIHF remains a challenging entity to improve perinatal outcome.
Subject(s)
Female , Humans , Infant, Newborn , Male , Anemia , Arrhythmias, Cardiac , Birth Weight , Cardiomegaly , Ductus Arteriosus, Patent , Ebstein Anomaly , Echocardiography , Foramen Ovale, Patent , Gestational Age , Heart Septal Defects, Atrial , Heart , Hydrops Fetalis , Hypoalbuminemia , Intensive Care, Neonatal , Parturition , Pericardial Effusion , Retrospective StudiesABSTRACT
OBJECTIVE: We undertook this study to find out clinical characteristics and prognostic factors of neonatal survival in nonimmune hydrops fetalis (NIHF). METHODS: From Oct. 1988 to Feb. 2001, 54 cases of nonimmune hydrops fetalis diagnosed at Seoul National University Hospital (SNUH) were included in our study. The incidence and perinatal mortality were investigated. The diagnostic work-up for associated conditions (or etiology) included detailed ultrasonography, karyotyping, fetal echocardiography, infection work-up (TORCH, parvovirus), and autopsy (if fetus was dead). Among 54 cases, 20 cases of liveborns were divided into two groups. Group I survived beyond neonatal period (survived>28 days) and group II did not (expired3 (OR=21, CI 1.77, 248.1; p3 (p<0.01). CONCLUSION: Over 3 of 1-min and 5-min AS were meaningful factors for neonatal survival in NIHF.
Subject(s)
Female , Pregnancy , Apgar Score , Autopsy , Echocardiography , Fetofetal Transfusion , Fetus , Gestational Age , Hydrops Fetalis , Incidence , Karyotyping , Parturition , Perinatal Mortality , Pleural Effusion , Polyhydramnios , Seoul , UltrasonographyABSTRACT
Hydrops fetalis is diagnosed when abnormal fluid collections are manifest in two or more fetal compartmnets including abdominal ascite, pleural effusion, percardial effusion, skin edema, polyhydroamniosis and placental edema. Although fetal hydrops was historically most commonly associated with Rh blood group isoimmunization, the availability of Rh immunoglobulin has increased the proportion of fetuses affected due to nonimmune etiologies. Neuroblastoma is a malignant tumor which originates in the autonomous nervous system. Congenital neuroblastoma is the most common solid malignant tumor of the neonatal period, incidence ranges 1:10,000 of all live births, retroperitoneal space being the most frequent localization. We have experienced a case of nonimmune hydrops fetalis with neuroblastoma at 32 weeks of gestation in 39 year old woman and reported that with brief review of related literatures.
Subject(s)
Adult , Female , Humans , Pregnancy , Edema , Fetus , Hydrops Fetalis , Immunoglobulins , Incidence , Live Birth , Nervous System , Neuroblastoma , Pleural Effusion , Retroperitoneal Space , SkinABSTRACT
BACKGROUND: Nonimmune hydrops fetalis has become an important perinatal problem since it was first described in 1943. Although recent advances in antenatal ultrasound have made it possible to detect and manage nonimmune hydrops fetalis in early pregnancy, the perinatal mortality is still high. OBJECTIVE: To obtain clinically useful data regarding antenatal diagnosis, management, and perinatal outcomes of nonimmune hydrops fetalis, and to assist clinicians offer proper antepartum counseling and obstetric management which may be able to improve prognosis. Study design: We retrospectively reviewed 33 cases of nonimmune hydrops fetalis delivered in our hospital over a 4-year period. RESULTS: The antenatal diagnosis was possible by ultrasonography in all cases. Accumulation of fluid in fetal serous cavity and generalized skin edema were observed in all cases. A probable etiology was found in 23 (69.7%) cases through ultrasonography, various laboratory studies including fetal karyotyping, and autopsies. These were cardiovascular (4), respiratory (6), chromosomal (4), skeletal (1), and others (8). Despite extensive diagnostic studies, no definite etiology was found in 10 (30.3%) cases. Excluding the ten fetuses delivered after induced abortion, eight infants were born alive and six died in the neonatal period. The mortality rate was 91.3% (21/23). CONCLUSION: Nonimmune hydrops fetalis represents a very poor perinatal outcome. It is suggested that to improve the prognosis, various antenatal and postnatal approaches to find associated etiologic factors should be performed, and intensive perinatal cares are needed.
Subject(s)
Female , Humans , Infant , Pregnancy , Abortion, Induced , Autopsy , Counseling , Edema , Fetus , Hydrops Fetalis , Karyotyping , Mortality , Perinatal Mortality , Prenatal Diagnosis , Prognosis , Retrospective Studies , Skin , UltrasonographyABSTRACT
Hydrops fetalis is diagnosed when abnormal fluid collections are manifest in two or more fetal compartments, including abdominal ascites, pleural effusions, pericardial effusions, skin edema, polyhydroamniosis and placental edema. Although fetal hydrops was hystorically most commonly associated with Rh blood group isoimmunization, the availability of Rh immunoglobulin has increased the proportion of fetuses affected due to nonimmune etiologies. We have experienced a case of nonimmune hydrops fetalis at 32 weeks of gestation in a 27-year-old woman and reported that with brief review of related literatures.
Subject(s)
Adult , Female , Humans , Pregnancy , Ascites , Edema , Fetus , Hydrops Fetalis , Immunoglobulins , Pericardial Effusion , Pleural Effusion , SkinABSTRACT
Nonimmune hydrops fetalis(NIHF) is a heterogenous disorder resulting from a vast number of underlying pathologies. Chromsomal abnormalities underlie a large percentage of cases of NIHF in most series. There are many reports identifying the association of Turner syndrome and Trisomy 21, 18, 13 with NIHF, but few reports about Klinefelter syndrome. In this article, we experienced a case of Klinefelter syndrome combined with hydrops fetalis and report the case with brief review of literature.
Subject(s)
Down Syndrome , Edema , Hydrops Fetalis , Klinefelter Syndrome , Pathology , Turner SyndromeABSTRACT
Nonimmune hydrops fetals is defined as generalized edema of the fetal soft tissue in utero and may be associated with effusion in the serous cavities without hematologic evidence of isoimmunization. The most common demonstrable causes are cardiac anomalies, followed by chromosomal disorders, congenital malformations, alpha-thalassemia, and the twin-twin transfu-sion syndrome. We have experienced a case of nonimmune hydrops fetalis in identical twin which caused by congenital mitral valve insufficiency and disappeared spontaneously at 35 wks. Now we report a case of nonimmune hydrops fetalis that slowly and spontaneously imp-roved without interventions with a brief review of related literatures.
Subject(s)
Humans , alpha-Thalassemia , Chromosome Disorders , Edema , Hydrops Fetalis , Mitral Valve Insufficiency , Twins, MonozygoticABSTRACT
No abstract available.
Subject(s)
Ascites , Hydrops Fetalis , Pleural Effusion , UltrasonographyABSTRACT
Nonimmune hydrops fetalis is becoming a predominant form of fetal hydrops due to the declining incidence of immune hydrops fetalis triggered by Rh isoimmunization. Infantile polycystic kidney appeared to be related to hydrops fetalis whether it is causal or merely coincidental and may represent another entry to differential diagnoses. Infantile polycystic kidney was diagnosed by an elevated maternal serum alpha-fetoprotein (AFP) value coupled with an ultrasonographic abnormality scanned as a multicystic mass with ascites in the fetal abdomen antenatally. This study presents a case of infantile polycystic kidney that resulted in a stillborn baby with hydrops fetalis and extensive placental calcification; it was the first case in Korea in which nonimmune hydrops fetalis was associated with infantile polycystic kidney in consecutive siblings by autosomal recessive inheritance in one family. In addition, this paper comprehensively reviews the incidence, etiology, prenatal diagnosis and proper management of nonimmune hydrops fetalis.