A case of fetal hydrops: prenatal diagnosis and neonatal management

Roberta Granese, Grazia Foti, Caterina Iozzo, Alessia Giofrè, Ilenia Panasiti, Gabriella D'Angelo, Lucia Marseglia, Eloisa Gitto


Hydrops fetalis (HF) is a serious fetal condition defined as an abnormal fluid accumulation in fetal extravascular compartments and body cavities caused by either immune or non immune conditions. Immune hydrops is caused by fetal hemolysis medi¬ated by circulating maternal antibodies to fetal red blood cell antigens. Its most common determinant is rhesus incompatibility. Systemic Lupus Eritematosus (SLE) is another rare cause of immune fetal hydrops, when the pregnancy is complicated by the presence of a third degree congenital heart block (CHB). The Neonatal Lupus Syndrome occurs with a prevalence of 2%.
We reported the case of severe fetal hydrops in a 31 weeks pregnant woman affected by mild maternal D alloimmunization and SLE. Despite fetal hydrops and a mild positive indirect Coombs’ test, the flow-rate study with the Systolic Peak Velocity (PSV) of the MCA excluded a fetal anemia. At birth, blood gas showed a condition of severe metabolic and respiratory acidosis (pH 6.43, pO2 9.9 mmHg, pCO2 206 mmHg, Base Excess (BE) -35 mmol/l, HCO3- 2.7 mmol/l) and a mild anemia (Hemoglobin 10.3 g/dl). ECG revealed a normal sinus rhythm and a CHB was excluded. Despite the critical clinical condition, no cardiorespiratory or neurological adverse outcomes occurred in the newborn


hydrops fetalis; rhesus incompatibility; Systemic lupus erythematosus

Full Text:



1. Bellini, C., Hennekam, R., C., (2012) Non-immune hydrops fetalis: a short review of etiology and pathophysiology. Am J Med Genet A 2012;158A:597-605.

2. Randenberg, A., L., (2010) Nonimmune hydrops fetalis part I: etiol¬ogy and pathophysiology. Neonatal Netw;29:281- 95.

3. Favre, R., Dreux, S., Dommergues, M., Dumez, Y., Luton, D., Oury, J., F., (2004) Nonimmune fetal ascites: a series of 79 cases. Am J Obstet Gynecol, 190:407-12.

4. Liao, C., Wei, J., Li, Q., Li, J., Li, L., Li, D., (2007) Nonimmune hydrops fetalis diagnosed during the second half of pregnancy in Southern China. Fetal Diagn Ther, 22:302-5.

5. Heinonen, S., Ryynanen, M., Kirkinen, P., (2000) Etiology and out¬come of second trimester non-immunologic fetal hy¬drops. Acta Obstet Gynecol Scand, 79:15-8.

6. Bellini, C., Hennekam, R.,C., Fulcheri, E., Rutigliani, M., Morcaldi, G., Boccardo, F., (2009) Etiology of nonimmune hydrops fetalis: a systematic review. Am J Med Genet A, 149A:844e51.

7. Yeom, W., Paik, E.,S., An, J.,J., Oh, S.,Y., Choi, S.,J., Roh, C., R., (2015) Clinicalcharacteristics and perinatal outcome of fetal hydrops. Obstet Gynecol Sci. Mar;58(2):90-7.

8. Chilcott, J., Lloyd, Jones, M., Wight, J., Forman, K., Wray, J., Beverley, C., (2002) A review of the clinical effectiveness and cost effectiveness of routine anti-D prophylaxis for pregnant women who are Rhesus (RhD) negative. London: National Institute of Clinical Excellence. Health Technol Assess, 7(4):iii-62. Review

9. Basu, (2011) Hemolytic disease of the fetus and newborn: Current trends and perspectives. Asian J Transfus Sci, 5(1): 3–7.

10. McCauley, C., J., (2017) A review of maternal alloimmunisation to Rh D in Northern Ireland. Transfus Med., 27(2):132-135.

11. Zhan, Z1, (2017) Fetal outcomes and associated factors of adverse outcomes of pregnancy in southern Chinese women with systemic lupus erythematosus. PLoS One, 12(4): e0176457.

12. Abrams, M., E., Meredith, K., S., Kinnard, P., Clark, RH., (2007) Hydrops fetalis: a retrospective review of cases reported to a large national database and identification of risk factors asso¬ciated with death. Pediatrics, 20:84-9.

13. Randenberg, A., L. Nonimmune hydrops fetalis part II: does etiology influence mortality? (2010) Neonatal Netw, 29:367-80.

14. Simpson, J., H., McDevitt, H., Young, D., Cameron, A., D. (2006) Sever¬ity of non-immune hydrops fetalis at birth continues to predict survival despite advances in perinatal care. Fetal Diagn Ther, 21:380-2.

15. Moreno, C., A., Kanazawa, T., Barini, R., Nomura, M., L., An¬drade, K., C., Gomes, C., P. (2013) Non-immune hydrops fetalis: a prospective study of 53 cases. Am J Med Genet A, 161A:3078-86.

16. Fukushima, K., Morokuma, S., Fujita, Y., Tsukimori, K., Satoh, S., Ochiail, M., (2011) Short-term and long-term outcomes of 214 cases of non-immune hydrops fetalis. Early Hum Dev, 87:571-5.

17. Sohan, K., Carroll, S., G., De La Fuente, S., Soothill, P., Kyle, P., (2001) Analysis of outcome in hydrops fetalis in relation to gestational age at diagnosis, cause and treatment. Acta Obstet Gynecol Scand, 80:726-30.

18. Basu, S., (2011) Hemolytic disease of the fetus and newborn: Current trends and perspectives Asian J Transfus Sci, 5(1): 3–7.

19. Takci, S., Gharibzadeh, M., Yurdakok, M., Ozyuncu, O., Korkmaz, A., Akcoren, Z., (2014) Etiology and outcome of hydrops fetalis: report of 62 cases. Pediatr Neonatol, 55(2):108-13.

20. Kim, S., A., Lee, S., M., Hong, J., S., Lee, J., Park, C., W., Kim, B., J., (2014) Ultrasonographic severity scoring of non-immune hy¬drops: a predictor of perinatal mortality. J Perinat Med, 43(1):53-9. doi: 10.1515/jpm-2013-0208.

21. Bowman JM. Hemolytic disease of the newborn. VoxSanguinis 1996;70:62–7.

22. Brucato, A., Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: a prospective study of 100 women. Arthritis Rheum, 44(8):1832-5.

23. Buyon, J., P., (2009) Autoimmune associated congenital heart block: integration of clinical and research clues in the management of the maternal ⁄ foetal dyad at risk. J Intern Med, 265(6):653-62.

DOI: https://doi.org/10.6092/1828-6550/APMB.106.1.2018.A2


  • There are currently no refbacks.

Copyright (c) 2018 Roberta Granese, Grazia Foti, Caterina Iozzo, Alessia Giofrè, Ilenia Panasiti, Gabriella D'Angelo, Lucia Marseglia, Eloisa Gitto

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.