IMMUNE FETAL HYDROPS - A SEVERE FORM OF RH ISOIMMUNIZATION
The prevalence of pregnancies with Rh isoimmunization decreased to about 0.6% of all cases due to anti-D immune globulin prophylaxis. Rh incompatibility or Rh isoimmunization pregnancies must be monitored by serial measurements of titers of maternal Rh antibodies and, if possible, by serial Doppler evaluation of peak systolic velocity in the middle cerebral artery. Nowadays, for the detection of fetal blood group and Rh we can use techniques which identify free fetal DNA in maternal plasma. We report the clinical case of a 35 years old woman, admitted to our clinic after not being able to perceive active fetal movement. She proved to be Rhesus negative, with a pathological obstetrical history and through ultrasound examination, the diagnosis of fetal hydrops was established. The presence of fetal hydrops determines the viability of a small percentage of about 11%, and the long-term prognosis of these children is burdened by the need of repeated transfusions to combat the inhibition of erythropoiesis. Our report highlights the importance of early diagnose and precise antibody monitoring, to provide proper management and prophylaxis.
2. Bellini C, Hennekam RC. Non-immune hydrops fetalis: a short review of etiology and pathophysiol-ogy. Am J Med Genet A 2012; 158A (3): 597-605.
3. Randenberg AL. Nonimmune hydrops fetalis part I: etiology and pathophysiology. Neonatal Netw 2010; 29(5): 281-295.
4. Ratanasiri T, Komwilaisak R, Sittivech A, et al. Incidence, causes and pregnancy outcomes of hydrops fetalis at Srinagarind Hospital, 1996-2005: a 10-year review. J Med Assoc Thai 2009; 92(5): 594-599.
5. Liao C, Wei J, Li Q, et al. Nonimmune hydrops fetalis diagnosed during the second half of pregnancy in Southern China. Fetal Diagn Ther 2007; 22: 302-305.
6. Takci S, Gharibazadeh M, Yudakok M, et al. Etiology and Outcome of Hydrops Fetalis: Report of 62 Cases, Pediatrics and Neonatology, 2014; 55(2):108-113
7. Czernik C, Proquitté H, Metze B, Bührer C. Hydrops fetalis--has there been a change in diagnostic spectrum and mortality? J Matern Fetal Neonatal Med 2011; 24(2): 258-263.
8. Fukushima K, Morokuma S, Fujita Y, et al. Short-term and long-term outcomes of 214 cases of non-immune hydrops fetalis. Early Hum Dev 2011; 87(8): 571-575.
9. Ota S, Sahara J, Mabuchi A, et al. Perinatal and one-year outcomes of non-immune hydrops fetalis by etiology and age at diagnosis. J Obstet Gynaecol Res 2016; 42(4): 385-391
10. Sohan K, Carroll SG, De La Fuente S, et al. Analysis of outcome in hydrops fetalis in relation to gestational age at diagnosis, cause and treatment. Acta Obstet Gynecol Scand 2001; 80: 726-730
11. Ruano R, Ramalho AS, Karina A, et al. Prenatal diagnosis and natural history of fetuses presenting with pleural effusion. Prenat Diagn. 2011; 31(5):496–9
12. Desilets V, Audibert F, Investigation and management of non-immune fetal hydrops, J Obstet Gynaecol Can 2013; 35 (10): 923-938
13. Kim SA, Lee SM, Hong JS, Lee J, Park CW, Kim BJ, Park KH, Park JS, Jun JK. Ultrasonographic severity scoring of non-immune hydrops: a predictor of perinatal mortality. J Perinat Med 2015; 43(1): 53-59.
14. Titianu M., Schaas C., Onofriescu M. Diagnostic problems in fetal echocardiographic examination. Observations on a lot of study during 2005-2010. Rev Med Chir Soc Med Nat Iasi 2011; 115(2): 451-454.
15. Kaczmarek P, Jaczewski B, Oszukowski P, Respondek-Liberska M. Non-immune hydrops fetalis--prognostic factors based on fetal echo (analysis in 230 cases). Ginekol Pol 2003; 74(10): 1112-1117.
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