There are two types of hydrops fetalis: Immune and nonimmune. The exact cause depends on which form a baby has.
Immune hydrops fetalis is a complication of a severe form of Rh incompatibility. Rh compatibility causes massive red blood cell destruction, which leads to several problems, including total body swelling. Severe swelling can interfere with how the body organs work.
Nonimmune hydrops fetalis occurs when a disease or medical condition disrupts the body's ability to manage fluid. There are three main causes for this type: heart or lung problems, severe anemia (thalassemia), and genetic defects, including Turner syndrome.
The number of babies who develop immune hydrops fetalis has dramatically decreased since the introduction of the medicine RhoGAM, which is used to treat pregnant mothers at risk for Rh incompatibility.
Symptoms depend on the severity of the condition. Mild forms may cause:
Change in skin color (pallor)
More severe forms may cause:
Bruising or purplish bruise-like spots on the skin
Total body swelling
Exams and Tests
An ultrasound done during pregnancy may show:
High amounts of amniotic fluid
Abnormally large placenta
Fluid that leads to swelling in the unborn baby's belly area and organs, including the liver, spleen, heart, or lung area
An amniocentesis and frequent ultrasounds will be done to determine the severity of the condition.
Treatment depends on the cause. During pregnancy, treatment may include:
Medicine to cause early labor and delivery of the baby
Early cesarean delivery if condition gets worse
Giving blood to the baby while still in the womb (intrauterine fetal blood transfusion)
Treatment for a newborn may include:
Direct transfusion of packed red blood cells (compatible with the infant's blood type) and an exchange transfusion to rid the baby's body of the substances that are destroying the red blood cells
Using a needle to remove extra fluid from around the lungs and belly area
Medicines to control heart failure and help the kidneys remove extra fluids
Methods to help the baby breathe, such as a breathing machine
Hydrops fetalis often results in death of the infant shortly before or after delivery. The risk is highest among the most premature babies and those who are severely ill at birth.
Rh incompatibility, which can lead to this condition, can be prevented if the mother takes a medicine called RhoGAM at certain times during and after pregnancy.
Abrams ME, Meredith KS, Kinnard P, Clark RH. Hydrops fetalis: a retrospective review of cases reported to a large national database and identification of risk factors associated with death. Pediatrics. 2007 Jul;120(1):84-9.
Kumar V, Abbas AK, Fausto N. Robbins and Cotran Pathologic Basis of Disease. 7th ed. St. Louis, Mo: WB Saunders; 2005.
Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.