Incidence Of Hydrops Fetalis Research Articles

Predictors of Hydrops Fetalis Infants by Mode of Delivery

BACKGROUND: Hydrops fetalis is a fetal condition associated with higher perinatal and neonatal mortality and morbidity. The overall survival rate from the diagnosis is today estimated to be 27% despite advanced intrauterine and neonatal care. Factors that contribute to poor perinatal and neonatal outcomes have been identified; however, little is known about the existing specific predictor tool of perinatal outcome by mode of delivery. 
 OBJECTIVE: the study aimed to determine whether cesarean section does improve the perinatal outcomes of hydrops fetalis infants.
 STUDY DESIGN: This was a retrospective cohort study that retrieved 102 medical records of pregnancies complicated by hydrops fetalis. For all those women, the transabdominal ultrasound was performed during pregnancy as part of the standard diagnostic modality of intrauterine hydrops fetalis. All pregnant women’s and their newborn’s medical records were retrieved and reviewed to collect information related to the outcomes as per the mode of delivery either by cesarean section or vaginal delivery. Based on the severity of fetal disease as described by obstetric ultrasound findings, pregnant women were divided into 4 groups: mild, moderate, moderately severe, and severe hydrops fetalis. The significance of the obtained data was set at two-tailed p<0.05. The chi-squared test was used to compare categorical between groups based on outcomes. Fisher’s exact test or Monte Carlo correction was used for chi-squared analysis when more than 20% of the cells had an expected count <5. The odds ratio and 95% confidence interval for perinatal adverse outcomes were calculated using logistic regression.
 RESULTS: The incidence of hydrops fetalis was estimated to be 1.1% in this cohort study. The non-immune hydrops fetalis was the common type, accounting for 75.6% of all cases. Perinatal mortality occurred in 55.9% and the 7-day survival was estimated at 44.1%. The mortality rate was 66.1% in non-immune hydrops fetalis. There was a statistically significant association between the mode of delivery and the overall survival (pv-0.04). However, survival was increased in class I and class II (55.0%), while survival was equally observed in classes III and IV (22.5%). There was a statistically significant association between the class and survival (pv <.001). Birth weight of ≥3000 grams was associated with reduced poor perinatal outcomes at 0.3% (pv-0.02, 95% CI=0.14 -0.85). Similarly, admission to the newborn unit was associated with reduced mortality by 2.5% (pv-0.04, 95% CI=1.0 - 6.4).
 CONCLUSION: Cesarean section delivery does not improve the perinatal outcomes of hydrops fetalis newborns and it should be considered only for maternal concerns. The predictor tool of perinatal outcomes of hydrops fetalis infant per mode of delivery is a useful tool to assist in decision-making and predict the perinatal outcome of hydrops fetalis per mode of delivery.
 

Clinical Profile and Predictors of Mortality in Neonates Born With Non-Immune Hydrops Fetalis: Experience From a Lower-Middle-Income Country.

IntroductionHydrops fetalis (HF) is a life-threatening condition in which a fetus has an abnormal collection of fluid in the tissue around the lungs, heart, abdomen, or under the skin. Based on its pathophysiology, it is classified into immune and non-immune types. With the widespread use of anti-D immunoglobulin, non-immune HF has become more common, with an incidence of one in 1,700-3,000 live births. A multitude of fetal diseases with various causes can lead to non-immune HF. Due to the recent advances in prenatal diagnostic and therapeutic interventions together with improved neonatal intensive care, the diagnosis and subsequent management of HF have been refined. However, HF is still associated with a high mortality rate. A recent assessment of the literature found that there is a lack of data on prognostic variables in neonates with HF from low- and middle-income countries. In light of this, we sought to establish the etiologic causes, predictors of mortality, and eventual fate of newborns born non-immune HF at the Aga Khan University Hospital, Karachi during the 10-year period spanning January 2009-December 2019 in this retrospective analysis.MethodologyFor this study, we collected data from the computerized database and patient record files at the hospital on all infants with non-immune HF. Demographic data, postnatal interventions, clinical and laboratory findings, outcomes, and the results of comparison between HF patients who died and those who survived were analyzed.ResultsThe incidence of non-immune HF at our hospital was 0.62/1,000 live births during the period under study, with 33 newborn babies diagnosed with non-immune HF from a total of 53,033 live-born deliveries. An etiologic factor was discovered in 17 (51.5%) neonates with non-immune HF while 16 (48.4%) were classified as those with unidentified etiology. The most common causes were cardiovascular and genetic syndromes, which resulted in 100% mortality. The overall mortality rate was 67%. The need for mechanical ventilation, surfactant therapy, and prolonged hospitalization were identified as independent risk factors of mortality.ConclusionOur study proves that the need for mechanical ventilation [moderate to severe hypoxic respiratory failure (HRF)] and prolonged hospitalization are strong predictors of poor outcomes in neonates with non-immune HF. Therefore, severe hydrops causing significant mortality can be anticipated based on the patients' respiratory status and the need for escalated oxygen support.

EVALUATION OF CAUSES, FREQUENCY AND PROGNOSIS OF HYDROPS FETALIS: A CASE- SERIES STUDY AT A REFERRAL HOSPITAL IN TEHRAN, IRAN

Introduction Hydrops Fetalis is a serious condition in fetal period, characterized by the presence of serous fluid accumulation in at least two potential spaces in fetus including pleural effusion, pericardial effusion, and ascites. The incidence of hydrops fetalis is one per 2500-3000 pregnancies. This condition is followed by different diseases. Fetal hemolytic anemia and its hypoxemia due to hydrops fetalis are potentially life or function threatening. Mortality rate is 50-90%; this poor prognosis is improving with advances in prenatal and medical treatment. Methods and Materials This study performed on patients’ records with hydrops fetalis diagnosis in one of the neonatal referral and academic center, Vali-e-Asr Hospital Tehran, the capital of Iran from 2003 to 2010. Etiology, prognosis, and frequency of Hydrops fetalis in newborns were evaluated. Results Out of 10878 cases, 0.35% was born with hydrops fetalis:18.42% immune [Rh incompatibility (%85.71), Kell antigen system(%14.29) ] and 81.58% non-immune. Conclusion The rate of hydrops due to Rh incompatibility is significant in our center (85.71%), however, it is unusual in most of medical centers all over the world.

Etiology and Outcome of Hydrops Fetalis: Report of 62 Cases

We aimed to define the etiologic and prognostic factors in live-born infants with hydrops fetalis (HF) in our tertiary neonatal intensive care unit over a 10-year period. Medical records of newborn infants with HF during 2002-2011 were reviewed retrospectively. Demographic data, prenatal interventions, clinical and laboratory findings, outcomes, and the results of postmortem examinations were analyzed. During the study period, 62 newborn infants with HF were identified from 16,200 live-born deliveries and the incidence of HF was 3.8/1000 live births in our hospital. Twenty-eight infants (45.2%) had immune HF, whereas 34 (54.8%) had nonimmune HF. An etiologic factor could be identified in 24 (70.5%) infants with nonimmune HF. Lymphatic dysplasias comprised the majority (23.5%) of the infants with nonimmune HF. Mortality rate was 50%. The presence of two or more serous cavity effusions and gestational age were independently associated with the risk of mortality. Despite the improvements in neonatal care, mortality rate in infants with HF is still high. Gestational age and the extent of serous cavity determine the risk of mortality. Timely and advanced prenatal or postnatal new therapeutic strategies may alter this fatal outcome in appropriate patients.

Transient Leukemia (Transient Myeloproliferative Disorder, Transient Abnormal Myelopoiesis) of Down Syndrome

Transient leukemia of Down syndrome (DS-TL), also known as transient myeloproliferative disorder of Down syndrome (DS) and transient abnormal myelopoiesis of DS, occurs in approximately 10% of DS neonates and in phenotypically normal neonates with trisomy 21 mosaicism. In DS-TL, peripheral blood analysis shows variable numbers of blasts and, usually, thrombocytopenia; other cytopenias are uncommon. Bone marrow characteristics of DS-TL are, likewise, variable, though (in contrast to other leukemias) the bone marrow blast differential can be lower than the peripheral blood blast differential. The blasts of DS-TL typically show light microscopic, ultrastructural, and flow cytometric evidence of megakaryocyte differentiation. DS-TL neonates have a approximately 15% risk of developing potentially fatal liver disease and show <10% incidence of hydrops fetalis. Additional manifestations of DS-TL include cutaneous involvement, hyperviscosity, myelofibrosis, cardiopulmonary failure, splenomegaly, and spleen necrosis. Despite its typical transient nature, 20% to 30% of DS-TL patients develop overt (nontransient) acute leukemia, usually within 3 years and typically of the M7 phenotype (acute megakaryoblastic leukemia). The pathogenesis of DS-TL (and of subsequent acute leukemia) involves mutation of GATA1 (on chromosome X), which normally encodes a transcription factor integral to normal development of erythroid, megakaryocytic, and basophilic/mast cell lines. The pathogenetic role of trisomy 21 in DS-TL is unclear. Though indications for chemotherapy in DS-TL have not been firmly established, the blasts of DS-TL are sensitive to low-dose cytosine arabinoside.

Long-term neurodevelopmental outcome after intrauterine transfusion for the treatment of fetal hemolytic disease

Objective: The aim of the study was to assess the developmental outcome of neonatal survivors of hemolytic disease of the neonate treated with modern intrauterine transfusion techniques. Study Design: In this prospective, observational study, auditory evoked-response tests were performed in the nursery. Neurodevelopmental evaluation with the Gesell Developmental Schedules was performed between 9 and 18 months of corrected age to assess motor skills, language development, comprehension capacity, and social skills. The McCarthy Scales of Children’s Abilities were administered between 36 and 62 months. Results: Forty children who survived severe fetal hemolytic disease were followed up until 62 months old. Demographic data included gestational age at first intrauterine transfusion (26.4 ± 3.7 weeks), median number of intrauterine transfusions (4, range 1-8), lowest fetal hematocrit (20.2%± 7.8%), peak fetal bilirubin (7.1 ± 2.1 mg/dL), incidence of hydrops fetalis (45%),and mean gestational age at delivery (35.6 ± 2.2 weeks). One case of severe bilateral deafness and 1 case of right spastic hemiplegia were diagnosed. The Gesell Developmental Schedules score was assessed between 9 and 18 months of corrected age in 22 infants. The global developmental quotient was 101.9 ± 9.5 (mean for normal population is 100). Regression analysis revealed no correlation between the global developmental quotient and gestational age at the first intrauterine transfusion, gestational age at birth, or the severity of the fetal hemolytic disease (fetal hematocrit, fetal bilirubin, presence of hydrops fetalis, total number of intrauterine transfusions, duration of neonatal phototherapy, and number of neonatal exchange transfusions). Eleven of the 40 children were followed up until they were 62 months old, and the McCarthy Scales of Children’s Abilities were administered. The mean cognitive index was 107.6 ± 9.4 (90-109 is considered average). Conclusion: Despite severe fetal hemolytic disease, normal developmental outcome can be expected for children treated with intrauterine transfusions. (Am J Obstet Gynecol 1998;179:858-63.)

Nonimmune Hydrops Fetalis

Eleven years after the licensing of Rh immune prophylaxis (RhoGAM or Rhlg), it is not surprising that the incidence of classic erythroblastosis fetalis has declined dramatically. Previously, an Rh negative mother had a 15% chance of developing an Rh antibody following pregnancy with an Rh positive infant. With RhoGAM prophylaxis, the rate of sensitization has been reduced to 1%, according to a worldwide cooperative study. The decline in the frequency of Rh isoimmunization has resulted in a decrease in the total incidence of hydrops fetalis, but there has been an increase in the relative proportion of nonimmune hydrops fetalis. In 1970, it was estimated that approximately 20% of cases of hydrops fetalis in Western countries were nonimmunologic; today, 4/5 (80%) cases seen at the Children's Hospital in New Jersey are nonimmunologic in nature.