Neonatology pp 1515-1522 | Cite as

Fetal and Neonatal Hydrops

  • Gennaro VetranoEmail author
  • Mario De Curtis
Reference work entry


Hydrops fetalis (i.e., fetal hydrops) (HF) is a serious condition defined as abnormal accumulation of fluid in two or more fetal compartments. It presents as ascites, pleural effusion, pericardial effusion, and skin edema. In some patients, it may also be associated with polyhydramnios and placental edema. Potter was the first to distinguish nonimmune hydrops fetalis (NIHF) from immune hydrops. These days approximately 90% of cases of hydrops fetalis are due to nonimmune diseases. The basic mechanism for the formation of HF is an imbalance between interstitial fluid production and lymphatic return. The antenatal diagnosis of HF is made by the ultrasound finding of fluid accumulation in the fetus or placenta. The management of hydrops fetalis is a great challenge for fetal medicine specialists and neonatologists and the mortality rate still remains high.


  1. Abrams ME, Meredith KS, Kinnard P, Clark RH (2007) Hydrops fetalis: a retrospective review of cases reported to a large national database and identification of risk factors associated with death. Pediatrics 120(1):84–89CrossRefGoogle Scholar
  2. American Heart Association (2006) 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support. Pediatrics 117(5):e989–e1004CrossRefGoogle Scholar
  3. American Pregnancy Association (2006) Fetal Non-Stress Test (NST).
  4. Apkon M (1995) Pathophysiology of hydrops fetalis. Semin Perinatol 19:437CrossRefGoogle Scholar
  5. Bellini C, Hennekam RC, Fulcheri E et al (2009) Etiology of nonimmune hydrops fetalis: a systematic review. Am J Med Genet A 149A:844–851CrossRefGoogle Scholar
  6. Bonvicini F, Puccetti C, Salfi NC et al (2011) Gestational and fetal outcomes in B19 maternal infection: a problem of diagnosis. J Clin Microbiol 49:3514–3518CrossRefGoogle Scholar
  7. Braun T, Brauer M, Fuchs I, Czernik C, Dudenhausen JW, Henrich W, Sarioglu N (2010) Mirror syndrome: a systematic review of fetal associated conditions, maternal presentation and perinatal outcome. Fetal Diagn Ther 27:191–203CrossRefGoogle Scholar
  8. Bullard KM, Harrison MR (1995) Before the horse is out of the barn: fetal surgery for hydrops. Semin Perinatol 19(6):462–473. ReviewCrossRefGoogle Scholar
  9. Carr S et al (1995) Intrauterine therapy for homozygous alpha-thalassemia. Obstet Gynecol 85:876CrossRefGoogle Scholar
  10. Czernik C, Proquitté H, Metze B, Bührer C (2011) Hydrops fetalis: has there been a change in diagnostic spectrum and mortality? J Matern Fetal Neonatal Med 24:258–263CrossRefGoogle Scholar
  11. Désilets V, Audibert F et al (2013) Investigation and management of non-immune fetal hydrops. J Obstet Gynaecol Can 35(10):923–936CrossRefGoogle Scholar
  12. Fleischer AC et al (1981) Hydrops fetalis: sonographic evaluation and clinical implications. Radiology 141:163CrossRefGoogle Scholar
  13. Hoddick WK, Mahony BS, Callen PW, Filly RA (1985) Placental thickness. J Ultrasound Med 4:479–482CrossRefGoogle Scholar
  14. Holzgreve W, Curry CJ, Golbus MS, Callen PW, Filly RA, Smith JC (1984) Investigation of nonimmune hydrops fetalis. Am J Obstet Gynecol 150:805CrossRefGoogle Scholar
  15. Jones DC (1995) Nonimmune fetal hydrops: diagnosis and obstetrical management. Semin Perinatol 19(6):447–461CrossRefGoogle Scholar
  16. Lamont RF, Sobel JD, Vaisbuch E et al (2011) Parvovirus B19 infection in human pregnancy. BJOG 118:175–186CrossRefGoogle Scholar
  17. Lee AJ, Bethune M, Hiscock RJ (2012) Placental thickness in the second trimester: a pilot study to determine the normal range. J Ultrasound Med 31:213–218CrossRefGoogle Scholar
  18. Mahone PR, Sherer DM, Abramowicz JS, Woods JR Jr (1993) Twin-twin transfusion syndrome: rapid development of severe hydrops of the donor following selective feticide of the hydropic recipient. Am J Obstet Gynecol 169(1):166–168CrossRefGoogle Scholar
  19. Mahony BS, Filly RA, Callen PW, Chinn DH, Golbus MS (1984) Severe nonimmune hydrops fetalis: graphic evaluation. Radiology 151:757CrossRefGoogle Scholar
  20. Manning F (1999) Fetal biophysical profile. Obstet Gynecol Clin North Am 26(4):557–577CrossRefGoogle Scholar
  21. Mari G, Deter RL, Carpenter RL et al (2000) Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization; Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med 342:9–14CrossRefGoogle Scholar
  22. Mascaretti RS, Falcão MC, Silva AM, Vaz FA, Leone CR (2003) Characterization of newborns with nonimmune hydrops fetalis admitted to a neonatal intensive care unit. Rev Hosp Clin Fac Med Sao Paulo 58(3):125–132. Epub 2003 Jul 22CrossRefGoogle Scholar
  23. McCoy MC, Katz VL, Gould N, Kuller JA (1995) Non-immune hydrops after 20 weeks’ gestation: review of 10 years’ experience with suggestions for management. Obstet Gynecol 85(4):578–582CrossRefGoogle Scholar
  24. McMahan MJ, Donovan EF (1995) The delivery room resuscitation of the hydropic neonate. Semin Perinatol 19(6):474–482CrossRefGoogle Scholar
  25. Moise KJ Jr, Carpenter RJ Jr, Hesketh DE (1992) Do abnormal Starling forces cause fetal hydrops in red blood cell alloimmunization? Am J Obstet Gynecol 167(4 Pt 1):907–912CrossRefGoogle Scholar
  26. Muller-Hansen I, Hackeloer BJ, Kattner E (1998) Pre- and postnatal diagnosis and treatment of hydrops fetalis-an interdisciplinary problem. Z Geburtshilfe Neonatol 202(1):2–9PubMedGoogle Scholar
  27. Norton ME, Chauhan SP, Dashe JS (2015) Society for maternal-fetal medicine (SMFM) clinical guideline #7: nonimmune hydrops fetalis. Am J Obstet Gynecol 212(2):127–139. Epub 2014 Dec 31. ReviewCrossRefPubMedGoogle Scholar
  28. Pasman SA, Meerman RH, Vandenbussche FP, Oepkes D (2006) Hypoalbuminemia: a cause of fetal hydrops? Am J Obstet Gynecol 194(4):972–975CrossRefGoogle Scholar
  29. Potter EL (1943) Universal edema of the fetus unassociated with erythroblastosis. Am J Obstet Gynecol 46:130CrossRefGoogle Scholar
  30. Randenberg AL (2010) Nonimmune hydrops fetalis part II: does etiology influence mortality? Neonatal Netw 29:367–380CrossRefGoogle Scholar
  31. Romero R et al (1988) Nonimmune hydrops fetalis. In: Romero R et al (eds) Prenatal diagnosis of congenital anomalies. Appleton & Lange, Norwalk, p 414Google Scholar
  32. Rubod C, Houfflin V, Belot F, Ardiet E, Dufour P, Subtil D, Deruelle P (2006) Successful in utero treatment of chronic and massive fetomaternal hemorrhage with fetal hydrops. Fetal Diagn Ther 21(5):410–413CrossRefGoogle Scholar
  33. Santo S, Mansour S, Thilaganathan B et al (2011) Prenatal diagnosis of non-immune hydrops fetalis: what do we tell the parents? Prenat Diagn 31:186–195CrossRefGoogle Scholar
  34. Santolaya J, Alley D, Jaffe R, Warsof SL (1992) Antenatal classification of hydrops fetalis. Obstet Gynecol 79:256PubMedGoogle Scholar
  35. Shinbane JS, Wood MA, Jensen DN et al (1997) Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 29(4):709–715CrossRefGoogle Scholar
  36. Simpson JM, Sharland GK (1998) Fetal tachycardias: management and outcome of 127 consecutive cases. Heart 79(6):576–581CrossRefGoogle Scholar
  37. Strasburger JF, Huhta JC, Carpenter RJ Jr et al (1986) Doppler echocardiography in the diagnosis and management of persistent fetal arrhythmias. J Am Coll Cardiol 7(6):1386–1391CrossRefGoogle Scholar
  38. Suwanrath-Kengpol C, Kor-anantakul O, Suntharasaj T, Leetanaporn R (2005) Etiology and outcome of non-immune hydrops fetalis in southern Thailand. Gynecol Obstet Invest 59:134–137CrossRefGoogle Scholar
  39. Teixeira A, Rocha G, Guedes MB, Guimarães H (2008) Newborn with nonimmune hydrops fetalis – the experience of a tertiary center. Acta Med Port 21(4):345–350. Epub 2008 Oct 24PubMedGoogle Scholar
  40. Van Selm M et al (1991) Maternal hydrops syndrome: a review. Obstet Gynecol Surv 46:785CrossRefGoogle Scholar
  41. Warsof S, Nicolaides K, Rodecket CL (1986) Immune and non-immune hydrops. Obstet Gynecol 29:533Google Scholar
  42. Watson J, Campbell S (1986) Antenatal evaluation and management in nonimmune hydrops fetalis. Obstet Gynecol 67(4):589–593PubMedGoogle Scholar
  43. Wesolowski A, Piazza A (2008) A case of mediastinal teratoma as a cause of nonimmune hydrops fetalis, and literature review. Am J Perinatol 25(8):507–512CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.U.O.C. Pediatria/Neonatologia/UTINOsp. “Sacro Cuore di Gesù”BeneventoItaly
  2. 2.Dipartimento Materno-InfantileUniversità “La Sapienza”RomeItaly

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