Study of the Non-Immune Hydrops Fetalis (NIHF) and its Management

Hydrops Fetalis is a Greek term that describes pathological fluid accumulation in fetal soft tissues and serous cavities, peritoneal, pleural, pericardial, scalp and body wall. Hydrops Fetalis is considered as a prenatal form of cardiac failure. It is broadly divided into two groups -Immune Hydrops Fetalis (IHF) and Non -Immune Hydrops Fetalis (NIHF). In previous years most of the Immune Hydrops Fetalis is caused by Erythroblastosis Fetalis secondary to Rh Iso-immunization with presence of maternal circulating red cell antibodies. IHF has now decreased with passive maternal immunization markedly up to 20% (1990). Recently, Non- immune Hydrops Fetalis (NIHF) is relatively more common and accounts for 90% of Hydrops Fetalis. NIHF is also defined as universal edema unassociated with Erythroblastosis Fetalis. It can be caused by wide variety of factors including fetal disorders (Chromosomal abnormalities, Congenital malformation & Twinning), Cardiovascular, metabolic causes, maternal diseases (Diabetes, Hypothyroidism, Anemias), placental and cord abnormalities and infectious pathogens acquired in-utero (Cytomegalovirus). The incidence of NIHF is estimated at 1 in 3000 pregnancies. The aetiology of Hydrops Foetalis is based on the presence or absence of anaemia leading to heart failure and generalized oedema in the foetus and neonate. In approximately 1/4 of all cases, the cause is not determined.