Pregnancy is a wonderful time in a woman's life. During this period, it is necessary to carefully monitor your he alth and the intrauterine development of the baby, because even minor failures or the addition of an infection can lead to irreparable consequences, one of which is non-immune dropsy of the fetus. What is it and what consequences this disease can cause, we will consider in the article.
Definition
Dropsy is a pathological condition that occurs during the intrauterine development of the fetus, and is characterized by the accumulation of fluid in any cavity of the body. There are two types of this disease:
- Immune. The main reason for the development of dropsy of this type is the Rh conflict between the mother and the fetus. Currently, the pathology is successfully treated, which leads to low mortality.
- Non-immune hydrops fetalis (ICD-10 assigned code P83.2). A more dangerous type of disease that can provoke many factors. Despite the fact thatmedicine does not stand still, this pathology has a large percentage of deaths. This is especially true for children born prematurely. With non-immune dropsy of the fetus, the prognosis will be positive if the pathology is diagnosed at an early stage. This will identify and eliminate the provoking factor, as well as determine the most effective treatment plan. A photo of non-immune fetal dropsy (ultrasound) is presented below.
Reasons
The causes of non-immune dropsy of the fetus are still not fully understood and are characterized only by the repetition of some manifestations. Despite this, the most common factors provoking the development of pathology are distinguished:
- Chromosomal pathologies. These include triploidy, Shereshevsky-Turner syndrome.
- Various infections. For example, toxoplasmosis, measles, rubella and others.
- Pathologies of the cardiovascular system - congenital heart defects, vena cava thrombosis and others.
- Gene diseases. For example, achondrogenesis and Foam-Shockey syndrome.
- Anomalies of the thoracic region. These include diaphragmatic hernia and thoracic dysplasia.
- Congenital tumors.
- Defects in the development of the kidneys and other internal organs can also cause non-immune dropsy of the fetus.
- Metabolic disorders in a child.
- Pathologies of pregnancy. These include placental transfusion syndrome, cytomegaly, various viruses, placental chorioangioma, anemia, and maternal diabetes.
Diagnostic measures
To identify the pathological condition and the nature of its occurrence, a set of diagnostic measures is used. Consider them in more detail:
- The main diagnostic measure is ultrasound, which can reveal intrauterine signs of pathology and the degree of their development.
- The blood type and Rh factor are established. This study is very important to exclude the immune nature of the disease.
- The doctor conducts a survey of a pregnant woman, which specifies the presence of chronic diseases, infections and surgical interventions. The complications that arose during the period of bearing the baby and the general course of pregnancy are also important.
- General analysis of urine and blood.
- Biochemical blood test.
- ECG.
- Examining a woman for infections.
Intrauterine fetal examinations are ordered to confirm non-immune fetal hydrops during pregnancy:
- Examination of amniotic fluid.
- Cordocinthesis.
- PCR for suspected infections.
- Dopplerography.
Clinical picture
The first symptoms of non-immune fetal hydrops can be seen on an ultrasound. These include:
- decrease in fetal activity;
- subcutaneous edema;
- ascites;
- tachycardia;
- presence of fluid in body cavities;
- polyhydramnios;
- enlarged heart;
- abdomen enlarged due to ascites.
Women canmanifestations such as hypertension and massive edema appear.
But the most obvious signs are observed immediately after birth. The clinical picture allows you to almost accurately determine the disease:
- First of all, there is a serious condition of the baby.
- The sutures of the skull are open, the fontanel protrudes.
- There is swelling.
- Weakly expressed subcutaneous tissue, so body temperature is dependent on the environment.
- Depression of reflexes and low blood pressure are also diagnosed.
- Ascites is common.
- Enlarged liver and spleen.
Pregnancy and childbirth
After the diagnosis is confirmed, the woman is sent to the Center for Social and Social Development. Non-immune hydrops fetalis is a high-risk pathology that requires high-quality equipment and qualified specialists.
First of all, the compatibility of diagnosed anomalies with life is determined. The woman should be explained what are the possible consequences for the child in the future. Non-immune dropsy can provoke serious deviations in the development of the fetus, which will cause a significant decrease in the quality of life. If it is not possible to find out the cause of the development of the disease, it is impossible to prescribe an effective treatment, then termination of pregnancy is recommended. If a decision is made to keep the child, additional examinations are carried out, the results of which help to decide what would be more correct in this particular case - premature delivery orprolongation of pregnancy. The choice is complicated by the fact that non-immune dropsy is prone to spontaneous remission.
Decision on delivery is made based on the condition of the woman and the degree of maturity of the baby's lungs. Before delivery, an ultrasound examination is performed to assess for the presence of ascites and effusion. This will prepare for possible fluid aspiration. In most cases, a caesarean section is recommended, as there is a risk of asphyxia during vaginal delivery.
Possible treatment
When identifying the causes and consequences of non-immune fetal hydrops, a decision is made on possible treatment. This takes into account the severity and degree of development of the disease. A blood transfusion through the umbilical cord may be indicated. This procedure is recommended when the hematocrit falls below 30 g/l. After 2-3 weeks, the procedure is repeated if necessary. Transfusion is also indicated for severe anemia.
Before the birth of a baby, the delivery room is carefully prepared, equipped with all the necessary equipment for emergency resuscitation. A team of several neonatologists and resuscitators is being formed.
Immediately after birth, the following procedures are performed:
- pericardiocentesis, in which accumulated fluid is removed by puncture of the pericardial sac;
- pleural puncture - liquid contents are removed from the pleural cavity;
- laparocentesis - removal of liquid contents from the abdominal cavity.
These therapeutic measures are carried out under ultrasound control.
Assigned as needednext therapy:
- antibacterial;
- anticonvulsant;
- antihemorrhagic;
- metabolic and others.
It should be remembered that only well-organized and well-coordinated work of the medical staff in providing first aid to a newborn can be crowned with great success. During pregnancy, a woman and a child should be under close medical supervision.
Resuscitation in the postpartum period
Intensive care should start in the delivery room and includes the following actions by neonatologists and resuscitators:
- necessary to prepare fresh frozen plasma and packed red blood cells in advance;
- due to possible swelling of the airways, it is necessary to have an ETT of all sizes in the delivery room, since the method of breathing with a mask and bag is ineffective in this case;
- it is necessary to prepare drains that may be needed for various procedures and removal of excess fluid;
- need to be prepared for an emergency blood transfusion;
- calcium and glucose correction required;
- a catheter is inserted into the umbilical artery;
- treat with antibiotics and, if necessary, treat concomitant infectious diseases.
Newborn examinations
With non-immune dropsy, various examinations begin to be carried out in the delivery room. These include:
- taking blood from the umbilical cord, while detecting bilirubin,blood group, Rh factor, hematocrit and hemoglobin;
- blood chemistry is performed to detect urea, creatinine, total protein, ALT and AST;
- blood test to determine the level of glucose;
- infection testing;
- plain radiography;
- ascitic and pleural fluid tests, such as bacteriological culture;
- ultrasound examination of the abdomen and brain;
- additional tests to identify the cause of the disease.
Consequences
With non-immune dropsy of the fetus, the consequences for the child in the future can be quite serious. Even when diagnosing a pathology at an early stage of its development, there is a risk of complications, among which the following are the most common:
- pathology of the respiratory system;
- severe pathologies of the brain and cardiovascular system;
- pathology of the skin;
- heart failure;
- cryptorchism in boys;
- fatal.
Prevention
Non-immune dropsy is dangerous because the exact cause of its occurrence can very rarely be established. Preventive measures in this case are generally accepted recommendations during pregnancy. These include:
- pregnancy planning, during which the couple undergoes a comprehensive examination to identify and cure chronic, gynecological and hereditary diseases;
- timely registration at the antenatal clinic;
- systematic visits to the obstetrician-gynecologist and the implementation of all his recommendations;
- detection and full treatment of infectious, viral and somatic diseases of a woman during pregnancy;
- full and timely examination, appointed during the period of bearing the baby.
It is not recommended to neglect routine screenings and ultrasound, because it is with these examinations that a developing pathology can be detected.
Forecast
With non-immune dropsy of the fetus, the prognosis in most cases, unfortunately, is unfavorable. The number of surviving children is about 30%. Survival depends on how timely the pathology was diagnosed, as well as the presence of pathologies associated with this condition. For example, with pathologies of the heart, the prognosis will be more disappointing. The degree of influence of infectious diseases on the occurrence of dropsy depends on the duration of pregnancy. The later this condition developed, the more favorable the prognosis for the baby.
With the development of non-immune dropsy in the first half of pregnancy, there is a high risk of spontaneous abortion. At a later date, intrauterine fetal death may occur.
The prognosis will be favorable if the disease is diagnosed at an early stage of its development, and congenital pathologies of the heart and other vital organs have not been identified. Also of great importance is the ability to identify and then exclude the provoking factor.
Conclusion
Non-immune dropsyfetus is a very dangerous disease with a high mortality rate. The implementation of preventive measures during the planning and bearing of the baby will reduce the risk of pathology. Currently, medicine does not stand still. New ways of diagnosing the disease at an early stage are being created. Conditions are also being created for effective resuscitation of a newborn with this diagnosis, subsequent treatment and rehabilitation.
