Fetal hydrops results from an imbalance of interstitial fluidaccumulation and decreased removal of fluid by the capillariesand lymphatic system. Fluid accumulation can be secondary tocongestive heart failure, obstructed lymphatic flow, or decreasedplasma oncotic pressure (hypoproteinemic states). Edema formation is the final common pathway for many disease processesthat affect the fetus, including fetal cardiac, genetic, hematologic, metabolic, infection, or malformation syndromes.
The diagnostic workup of the hydropic fetus should focus on discovering the underlying cause. Maternal findings may include hypertension, anemia, multiple gestation, thickened placenta, and polyhydramnios, whereas fetal findings may include tachycardia, ascites, scalp and body wall edema, and pleural and pericardial effusion. Invasive fetal testing may be indicated. Amniocentesis provides amniotic fluid samples for karyotype, culture, alpha-fetoprotein, and metabolic and enzyme analysis. Percutaneous umbilical cord blood sampling can provide fetal blood for chromosomal analysis and hematologic and metabolic studies and provide a source for intervention (fetal transfusion for profound anemia).
Management depends on the underlying cause and the gestational age of the fetus. Resuscitative efforts at delivery are often required. It is often necessary to remove ascitic fluid from the abdomen or pleural fluid to improve ventilation. Profound anemia necessitates immediate transfusion with packed red blood cells.
The overall mortality for infants with nonimmune hydrops is approximately 50%. If the diagnosis is made before 24 weeks of gestation with subsequent premature delivery, the survival rate is approximately 4% to 6%.
Available @ StudentConsult.com
Respiratory distress that becomes manifested by tachypnea, intercostal retractions, reduced air exchange, cyanosis, expiratory grunting, and nasal flaring is a nonspecific response to serious illness. The differential diagnosis of respiratory distress includes pulmonary, cardiac, hematologic, infectious, anatomic, and metabolic disorders that may involve the lungs directly or indirectly. Surfactant deficiency causes respiratory distress syndrome (RDS), resulting in cyanosis and tachypnea; infection produces pneumonia, shown by interstitial or lobar infiltrates; meconium aspiration results in a chemical pneumonitis with hypoxia and pulmonary hypertension; hydrops fetalis causes anemia and hypoalbuminemia with high-output heart failure and pulmonary edema; and congenital or acquired pulmonary hypoplasia causes pulmonary hypertension and pulmonary insufficiency. It also is clinically useful to differentiate the common causes of respiratory distress according to gestational age (Table 61-1).
In addition to the specific therapy for the individual disorder, supportive care and evaluation of the infant with respiratory distress can be applied to all the problems mentioned earlier (Table 61-2). Blood gas monitoring and interpretation are key components of general respiratory care.