4. hydrops fetalis; pedatric pathology

Pediatric PathologyPediatric Pathology

Dr. Krishna Tadepalli, MD, www.mletips.com

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4. Hydrops Fetalis4. Hydrops Fetalis


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Fetal Hydrops• Accumulation edema fluid; Non-immune causes (CVS,

Chromosomal and Fetal anemia) are MC; Hydrops fetalis = generalized edema;

• Immune type

• Nonimmune type

• Three major causes – parvovirus B19– α-thalassemia – cardiovascular defects, chromosomal anomalies, and fetal anemia


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Fetal Hydrops• Accumulation edema fluid; Non-immune causes (CVS, Chromosomal and Fetal

anemia) are MC; Hydrops fetalis = generalized edema;

• Immune type


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Fetal Hydrops• Immune type• MC is Rh (mainly D Antigen) incompatibility between mother and fetus• Incidence is decreased in urban societies ( why?)

• Factors influence immune response =

– Concurrent ABO incompatibility protects

– depends on the dose of immunizing antigen (> 1 ml of Rh-positive fetal red cells)

– subsequent pregnancy has the risk

• Pathology

– Anemia due to hemolysis (extramedullary hematopoiesis )

– Jaundice due to hemolysis ( unconjugated bilirubin) kernicterus

– hypoxic injury to the heart and liver cardiac decompensation and failure generalized edema and anasarca


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Fetal Hydrops• Nonimmune type (table-10.4)• Three major causes (cardiovascular defects, chromosomal anomalies, and fetal

anemia ;- α- thalassemia &parvovirus B19)

• Morphology– stillborn, die within the first few days, or recover – Pale fetus and placenta (due to fetal anemia)– liver and spleen are enlarged ( due to congestion from cardiac failure)

– bone marrow hyperplasia of erythroid precursors & extramedullary hematopoiesis (compensatory)

– Erythroblastosis fetalis =large numbers of immature red cells, including reticulocytes, normoblasts, and erythroblasts in peripheral circulation

– blood bilirubin level greater than 20 mg/dL in term infants– Kernicterus =most serious; brain is enlarged and edematous and bright yellow in

color; affects mainly basal ganglia, thalamus, cerebellum, cerebral gray matter, and spinal cord

• Clinical = vary with the severity of the disease from Hepatosplenomegaly to Kernicterus

• Rx = for mild cases -phototherapy (visual light oxidizes unconjugated bilirubin ) and total exchange transfusion for severe cases


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Hydrops FetalisHydrops Fetalis


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KernicterusKernicterus


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4. hydrops fetalis; pedatric pathology

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