Pregnancy is a wonderful time in a woman’s life. During this period, it is necessary to carefully monitor your baby’s health and intrauterine development, because even minor malfunctions or infection can lead to irreparable consequences, one of which is the non-immune dropsy of the fetus. What are these and what consequences can cause this disease, we will consider in the article.
Definition
Dropsy is a pathological condition that occurs during fetal 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 of the mother and fetus. Currently, pathology is being successfully treated, which leads to low mortality.
- Immune dropsy of the fetus (in code ICD-10, code P83.2 is assigned). A more dangerous type of disease that can provoke many factors. Despite the fact that medicine does not stand still, this pathology has a large percentage of deaths. This is especially true for children born prematurely. With non-immune fetal dropsy, the prognosis will be positive if the pathology was diagnosed at an early stage. This will identify and exclude the provoking factor, as well as determine the most effective treatment plan. A photo of a non-immune fetal dropsy (ultrasound) is presented below.
Causes
The causes of non-immune fetal dropsy 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 pathology. 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 Pen – Shock syndrome.
- Anomalies of the thoracic region. These include diaphragm hernia and chest dysplasia.
- Congenital tumors.
- Also, malformations of the kidneys and other internal organs can become the cause of non-immune fetal dropsy.
- Metabolic disorders in a child.
- Pathology 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. Let's consider them in more detail:
- The main diagnostic measure is ultrasound, in which intrauterine signs of the pathology and the degree of their development can be detected.
- 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 clarifies the presence of chronic diseases, infections and surgical interventions. Complications and the general course of pregnancy that arose during the period of bearing the baby are also important.
- General analysis of urine and blood.
- Blood chemistry.
- ECG.
- Examination of a woman for infections.
Intrauterine fetal examinations are prescribed to confirm non-immune fetal dropsy during pregnancy:
- Examination of amniotic fluid.
- Cordocinthesis.
- PCR for suspected infections.
- Dopplerography.
Clinical picture
The first symptoms of non-immune fetal dropsy can be seen on an ultrasound scan. These include:
- decreased fetal activity;
- subcutaneous edema;
- ascites;
- tachycardia;
- the presence of fluid in the body cavities;
- polyhydramnios;
- enlarged heart;
- the abdomen is enlarged due to ascites.
A woman may develop symptoms such as hypertension and massive edema.
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 seams of the skull are open, the fontanel sticks out.
- Puffiness is observed.
- Subcutaneous tissue is poorly expressed, so body temperature is dependent on the environment.
- Inhibition of reflexes and low blood pressure are also diagnosed.
- Often ascites is noted.
- Enlarged liver and spleen.
Pregnancy and childbirth
After confirming the diagnosis, the woman is sent to the Central Center for Social Protection. Immune dropsy of the fetus is a pathology of increased danger, which requires high-quality equipment and qualified specialists.
First of all, it turns out the compatibility of diagnosed anomalies with life. Women should be explained what are the possible consequences for the child in the future. Non-immune dropsy can provoke serious abnormalities in the development of the fetus, which will cause a significant decrease in the quality of life. If it is not possible to determine the cause of the disease, it is impossible to prescribe an effective treatment, then termination of pregnancy is recommended. If a decision is made to save a child, additional examinations are carried out, the results of which help to decide what will be more correct in this particular case - premature delivery or prolongation of pregnancy. The choice is complicated by the fact that non-immune dropsy is prone to spontaneous remission.
The decision on delivery is made based on the condition of the woman and the degree of maturity of the baby's lungs. Before giving birth, an ultrasound examination is performed to assess the presence of ascites and effusion. This will prepare for possible aspiration of the fluid. In most cases, caesarean section is recommended, since in natural birth there is a risk of developing asphyxiation.
Possible treatment
When identifying the causes and consequences of non-immune fetal dropsy, a decision is made on a possible treatment. In this case, the severity and degree of development of the disease is taken into account. Blood transfusion through the umbilical cord may be indicated. This procedure is recommended when the hematocrit decreases 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 the baby, the maternity room is carefully prepared, equipping 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 the accumulated fluid is removed by puncture of the pericardial sac;
- pleural puncture - the liquid contents are removed from the pleural cavity;
- laparocentesis - removal of fluid contents from the abdominal cavity.
These therapeutic measures are carried out under the supervision of ultrasound.
As necessary, the following therapy is prescribed:
- 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 very successful. During pregnancy, a woman and a child should be under close medical supervision.
Postpartum resuscitation
Intensive care should begin in the delivery room and includes the following actions by neonatologists and resuscitators:
- it is necessary to prepare freshly frozen plasma and erythrocyte mass in advance;
- due to possible edema of the respiratory tract, it is necessary to have ETT of all sizes in the delivery room, since the method of breathing using a mask and a bag is ineffective in this case;
- it is necessary to prepare the drains, which may be necessary for carrying out various procedures and removing excess fluid;
- need to be prepared for an emergency blood transfusion;
- correction of calcium and glucose is required;
- a catheter is inserted into the umbilical artery;
- they are treated with antibiotics, and if necessary, concomitant infectious diseases are treated.
Examinations of the newborn
With non-immune dropsy, various examinations begin to be carried out in the delivery room. These include:
- taking blood from the umbilical cord, bilirubin, a blood group, Rh factor, hematocrit and hemoglobin are detected;
- a biochemical blood test is performed to detect urea, creatinine, total protein, ALT and AST;
- blood glucose test;
- research for infections;
- survey radiography;
- analyzes of ascitic and pleural fluid, for example, bacterial culture;
- ultrasound examination of the abdominal cavity and brain;
- additional tests to identify the cause of the disease.
Effects
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 most common are the following:
- pathology of the respiratory system;
- severe pathologies of the brain and cardiovascular system;
- pathology of the skin;
- cardiovascular failure;
- cryptorchidism in boys;
- fatal outcome.
Prevention
Immune dropsy is dangerous because it is very rare to establish the exact cause of its occurrence. 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 treat chronic, gynecological and hereditary diseases;
- timely registration in the antenatal clinic;
- systematic visits to the obstetrician-gynecologist and the implementation of all his recommendations;
- identification and full treatment of infectious, viral and somatic diseases of a woman during pregnancy;
- a full and timely examination, prescribed during the period of bearing the baby.
It is not recommended to neglect planned screenings and ultrasound, because it is with these examinations that you can identify a developing pathology.
Forecast
With non-immune fetal dropsy, the prognosis in most cases, unfortunately, is unfavorable. The number of surviving children is about 30%. Survival depends on how timely the diagnosis of pathology was, as well as the presence of pathologies associated with this condition. For example, with heart pathologies, the prognosis will be more disappointing. The degree of influence of infectious diseases on the occurrence of dropsy depends on the gestational age. The later this condition develops, the more favorable the baby's prognoses.
With the development of non-immune dropsy in the first half of pregnancy, there is a high risk of spontaneous abortion. At later dates, fetal death may occur.
The prognosis will be favorable if the disease was diagnosed at an early stage of its development, and congenital pathologies of the heart and other vital organs were not detected. Also of great importance is the possibility of identifying and subsequent exclusion of a provoking factor.
Conclusion
Immune dropsy of the fetus is a very dangerous disease with a high mortality rate. The implementation of preventive measures during the planning and bearing period of the baby will reduce the risk of pathology. Currently, medicine does not stand still. New methods for diagnosing the disease at an early stage are being created. The conditions are also created for the effective resuscitation of the newborn with this diagnosis, subsequent treatment and rehabilitation.