Most cases prevented by use of immunoglobulin (Ig) prophylaxis in at-risk mothers
About
- Fluid accumulation in > 2 body compartments
- Ascites, pleural effusion, pericardial effusion, skin oedema
Aetiology
- Immune (erythroblastosis fetalis): Rh blood group isoimmunization of the fetus.
- non-immune causes : Chromosomal anomalies, liver disease, heart/lung diseases, infections
Risks
- Rh negative, Iso immune blood group antibodies
- Prior administration of blood products
- Risks of illicit drug use, Indomethacin
- Collagen-vascular disease
- Age (< 16 y) or older (>35 y) maternal age
Clinical
- Anaemia with high output cardiac failure
- Fetal haemorrhage, large liver and spleen
- Severe abdominal swelling, enlarged liver, ascites
- Pleural effusion, pericardial effusion, and skin oedema
Differentials
Investigations
- USS 1st/2nd trimester shows fluid collections. May be polyhydramnios and placental oedema. Enlarged liver, spleen, or heart, and fluid buildup surrounding the fetus' abdomen, heart, and lungs
- Fetal blood sampling. This is done by placing a needle through the mother's uterus and into a blood vessel of the fetus or the umbilical cord.
- Amniocentesis. Involves withdrawing some of the amniotic fluid for testing.
Management
- Most cases prevented by the use of immunoglobulin (Ig) prophylaxis in at-risk mothers so there is a rise in the proportion that are non-immune
- Delivery may be by Caesarean section with resuscitation and intubation and ventilation if needed.
- Neonate needs ventilation, transfusion for severe anaemia, treat any hypoglycaemia, drainage of ascites and pleural effusions, Vitamin K, Furosemide
References