Click here to view next page of this article

Hydrops Fetalis

The diagnosis of hydrops fetalis is usually made by ultrasound. The current definition of Hydrops Fetalis implies that you are going to have skin edema greater than 5 mm and at least some effusions, two effusions, and two independent serous cavities, so may have some effusion in the pleura, you may have some ascites, you may have some pericardial effusion and this is what this slide is showing you, this is a pericardial effusion in an hydropic baby.

The body is fluid in motion, and by looking at this equation, if you see it in a simple manner, you will see that the capillary filtration rate is going to equal the lymphatic flow and that is going to be basically dependent on what is hydrostatic pressure in the capillary versus the interstitial pressure and what is colloid osmotic pressure in the plasma versus interstitial, so any alteration in this part of the equation is going to change this flow of water.

This is a baby with Turner syndrome and you see the cystic hygroma, this is again seen by ultrasound, cystic cavities at the back of the neck, very easy to diagnose. This is the case of rhabdomyomas, and you see two rhabdomyomas in the ventricles. To emphasize the point when you see these types of masses that may lead to congestive heart failure, you must think about the type of genetic syndrome, for example, tubular sclerosis.

Again, pediatric literature from 2006 and the first thing I want to emphasize, in these two series, termination of pregnancy at stillbirth occurring about 26% of this hydropic babies diagnosed in utero. Of those that did were born alive, when you look at the neonatal deaths, 46% versus 54%, who survived. Now you can see, depending on the etiology, that these authors were quoting, what was the rate of death versus survival, and you see again.

So now, there is an interest in doing serial amino reduction or even doing these types of procedures in the management of twin to twin transfusion syndrome and the results they get are better than those that are using laser ablation of the communications between the vessels, because as I said before, in twin to twin transfusion syndrome, the worse connection is the one that happens.

Another alternative of course, besides amino reduction and laser is cord ligation and this has been attempted in different ways, either by fetoscopy or by ultrasound guidance and of course if you ligate one of the cords, you will disconnect the whole process. This is the stream of this type of vascular connection and this is the trap syndrome, twin reversal arterial perfusion, and this is this mass, here is the normal twin, Im just pointing it out because it is not uncommon to see that they only have two vessels.