SAM domain variants of EPHB4 associated with aberrant signaling are linked to lymphatic-related fetal hydrops and facial dysmorphology.

Variants in EPHB4 (Ephrin type B receptor 4), a transmembrane tyrosine kinase receptor, have been identified in individuals with various vascular anomalies including Capillary Malformation-Arteriovenous Malformation syndrome 2 and lymphatic-related (non-immune) fetal hydrops (LRHF). Here, we identify two novel variants in EPHB4 that disrupt the SAM domain in two unrelated individuals. Proband 1 presented within the LRHF phenotypic spectrum with hydrops, and proband 2 presented with large nuchal translucency prenatally that spontaneously resolved in addition to dysmorphic features on exam postnatally. These are the first disease associated variants identified that do not disrupt EPHB4 protein expression or tyrosine-kinase activity. We identify that EPHB4 SAM domain disruptions can lead to aberrant downstream signaling, with a loss of the SAM domain resulting in elevated MAPK signaling in proband 1, and a missense variant within the SAM domain resulting in increased cell proliferation in proband 2. This data highlights that a functional SAM domain is required for proper EPHB4 function and vascular development.

Congenital metastatic neuroblastoma with placental involvement as a rare cause of non-immune fetal hydrops.

Non-immune hydrops fetalis represents the end-stage status of a variety of diseases, including metastatic tumors. We report a case of non-immune hydrops fetalis associated with multiple disseminated echogenic nodular lesions detected by ultrasound and confirmed by magnetic resonance. Cordocentesis demonstrated anemia and thrombopenia. Differential diagnosis included histiocytosis X, acute leukemia or metastatic disease. A stillbirth was diagnosed at week 25 + 6. The autopsy revealed hydrops fetalis, a right adrenal gland mass, multiple disseminated nodules histologically composed of small round blue cells positive for synaptophysin, and placental involvement, concordant findings with congenital undifferentiated neuroblastoma Stage M. No chromosomal abnormalities were associated, nor amplification abnormalities in MYCN and ALK genes. Metastatic neuroblastoma should be considered in the differential diagnosis of non-immune hydrops fetalis associated with multiple nodular lesions.

NT >99th centile and cystic hygroma: Which diagnosis, which management and outcome.

OBJECTIVES: To evaluate the prevalence of chromosomal anomalies in fetuses affected by increased nuchal translucency(iNT >99Th centile), cystic hygroma (CH) and cases progressing to fetal hydrops (NIHF) in order to correlate this result to prognosis and perinatal fetal outcomes, improving patient's counseling. METHODS: From January 2020 to December 2023, first trimester screening according to FMF criteria were performed in "Maternal fetal medicine Unit" of Foggia's hospital. We studied and collected clinical data of fetuses affected by nuchal translucency >99th centile (iNT), CH and cases progressing to Fetal Hydrops (non-immune fetal hydrop, NIFH). In these selected cases, we evaluated fetal Karyotype to demonstrate the presence of chromosomal abnormalities, associated to fetal structural anomalies and different pregnancy outcome. RESULTS: We have evaluated 45 cases of iNT, CH, and NIFH, identified by ultrasound during first trimester screening. Of these 45 pregnant women, four were lost to follow-up. Of the 41 pregnancies, 20 cases (48.8%) delivered at our division with newborns discharged in good health. Of the 21 patients (51.2%) who miscarried, only two miscarried spontaneously; the other 19 decided on a medical termination of pregnancy (MTP). The 19 patients who decided for MTP showed genetic abnormalities and/or malformation. The 20 cases of fetuses discharged as healthy newborns were enrolled with the following diagnoses: 5 had a diagnosis of CH (20% of cases), 1 case of NIFH (5% of cases), and 14 of iNT (75% of cases). All these fetuses had a normal karyotype and no major malformations. CONCLUSIONS: Isolated CH diagnosis is more frequent than described in Literature (5 cases out of 12: 41.7%) and their prognosis are better than previously described, with the same outcomes of fetuses with iNT without associated anomalies. The possibility of early diagnosis of chromosomal anomalies, associated malformations or the evolution into hydrops is essential for a complete consultation.

The role of fetal therapy in the management of mirror syndrome: a narrative review.

OBJECTIVES: Mirror syndrome (MS) is a condition characterized by the presence of maternal, fetal, and placental edema and is reversible through delivery or pregnancy termination. As fetal hydrops itself may be amenable to treatment, we sought to determine outcomes for MS primarily managed by fetal therapy through a narrative review of the literature and cases managed at our fetal center. STUDY DESIGN: PubMed, Embase, Web of Science, Scopus, and Google Scholar databases were searched through January 2024 using key words: mirror syndrome, Ballantyne's syndrome, fetal hydrops, maternal hydrops, pseudotoxemia, triple edema, maternal recovery, fetal therapy, and resolution. Manuscripts describing primary management by fetal therapy that included maternal and fetal outcomes were identified. Clinical details of MS patients managed with fetal therapy at our center were also included for descriptive analysis. RESULTS: 16 of 517 manuscripts (3.1%) described fetal therapy as the primary intended treatment in 17 patients. 3 patients managed at our center were included in the analysis. Among 20 patients undergoing primary fetal therapy for management of mirror syndrome, median gestational age of presentation was 24 weeks and 5 days gestation; predominant clinical findings were maternal edema (15/20), proteinuria (10/20), pulmonary edema (8/20), and hypertension (8/20); the primary laboratory abnormalities were anemia (8/20) and elevated creatinine or transaminases (5/20). Condition-specific fetal therapies led to resolution of hydrops in 17 (85%) cases and MS in 19 (95%) cases. The median time to hydrops resolution was 7.5 days and to resolution of mirror syndrome was 10 days. Fetal therapy prolonged pregnancy by a median of 10 weeks with a median gestational age of 35 weeks and 5 days at delivery. All women delivered for indications other than mirror syndrome and 19/20 fetuses survived. CONCLUSION: In appropriately selected cases, MS often resolves after fetal therapy of hydrops allowing for safe pregnancy prolongation with good maternal and infant outcomes.

Cardiovascular Effects of a Thoracoamniotic Shunt in a Fetus Affected by Isolated Right Congenital Diaphragmatic Hernia and Hydrops.

A thoracoamniotic shunt was placed in a fetus affected by a right congenital diaphragmatic hernia (RCDH) complicated by voluminous nonimmune hydrops (NIH) at 30 weeks of gestation. The fetus showed congestive cardiac failure with a combined cardiac output (CCO) of 460.7 ml/min (Z-score: -1.2). After seven days, no edema, ascites, or pleural effusion was present. CCO increased significantly, reaching a Z-score of -0.2, as well as right and left cardiac output (Z-scores: -0.3 and -0.8, respectively). Two weeks later, the cardiac function and the ascites got worse despite the correct shunt placement, suggesting a possible occlusion. At 33 weeks, a C-section was performed due to labor in breech presentation. Despite the intensive care provided, the newborn died due to pulmonary hypertension and respiratory insufficiency. The thoracoamniotic shunt's effect on fetal circulation and the mechanisms of NIH in the event of RCDH are still unclear. Due to the high mortality rate of this condition and its poorer outcomes compared to left-sided defects, shunting cannot be considered an efficient attempt to improve fetal and neonatal survival rates to date. A close relationship between the amount of lymphatic effacement and cardiac function is clear, but further studies are needed to provide more information about this severe condition and its treatment.

Mirror syndrome associated with fetal cardiomyopathy.

Mirror syndrome is a rare condition of generalized maternal oedema caused by fetal hydrops. A 37-year-old patient was admitted to our hospital because of suspected mirror syndrome caused by fetal cardiomyopathy. At 26th week of gestation patient developed bilateral pulmonary oedema as her condition rapidly deteriorated. Consequently, preterm labor was induced, percutaneous evacuation of fetal ascites was performed, and the patient finally vaginally delivered stillborn fetus. Although the initial postpartum period was severely complicated by hemorrhage, the condition of the patient significantly improved later, and she was discharged seven days after delivery. We believe this case is worth presenting due to its rarity and significant perinatal and obstetric challenges in treatment of those patients. Furthermore, preimplantation genetic testing could be performed to prevent at least some of the cases.

Free sialic acid storage disorders with fetal hydrops in a neonate / 中国当代儿科杂志

A boy, aged 3 hours, was admitted due to a prenatal diagnosis of fetal hydrops at 3 hours after resuscitation for birth asphyxia. Prenatal examination at 5 months of gestation showed massive ascites in the fetus, and after birth, the boy had the manifestations of systemic hydroderma, massive ascites, coarse face, and hepatomegaly. Genetic testing revealed heterozygous mutations in the SLC17A5 gene, and there was a significant increase in urinary free sialic acid. Placental pathology showed extensive vacuolization in villous stromal cells, Hofbauer cells, cytotrophoblast cells, and syncytiotrophoblast cells in human placental chorionic villi. The boy was finally diagnosed with free sialic acid storage disorders (FSASDs). This is the first case of FSASDs with the initial symptom of fetal hydrops reported in China. The possibility of FSASDs should be considered for cases with non-immune hydrops fetalis, and examinations such as placental pathology and urinary free sialic acid may help with early diagnosis and clinical decision making.

Foramen oval restrictivo intraútero: causa de hidrops fetal / Intrauterine restrictive oval foramen: cause of fetal hydrops

Introducción: El cierre prematuro del foramen oval o foramen oval restrictivo intraútero es una entidad clínica rara pero seria, de etiología desconocida. Puede ocasionar diversos defectos cardíacos, hipertensión pulmonar, insuficiencia cardiaca congestiva, hidrops fetal y muerte. El diagnóstico puede realizarse mediante ecocardiografía fetal, aunque en la mayoría de los casos sucede en autopsia posmortem. Objetivo: Describir un caso de hidrops fetal secundario al cierre prematuro del foramen oval intraútero. Presentación del caso: Recién nacido pretérmino de 34 semanas en el que, en ecografía y ecocardiografía prenatal se visualizó un aumento de las cavidades cardíacas asociado a cierre intrauterino de foramen oval e hidrops, hallazgos confirmados al nacimiento. Tras una prolongada estancia en unidad de cuidados intensivos neonatal y tratamiento con inotrópicos y diuréticos, se otorgó el alta hospitalaria con diagnóstico de cardiomiopatía dilatada secundaria a foramen oval restrictivo. Conclusiones: La asociación de cierre prematuro de foramen oval con hidrops fetal ha sido descripta en escasas publicaciones y es frecuente en estas la relación con muerte perinatal y con anomalías extracardíacas. En este caso se describe hidrops secundario al cierre temprano del foramen oval intraútero que condicionó a la dilatación global de cavidades cardíacas y a la disfunción ventricular severa persistentes más allá del periodo neonatal sin otras anomalías asociadas. A pesar de la severidad del compromiso cardiovascular, la evolución clínica fue favorable y permitió el egreso hospitalario. Es importante el reconocimiento temprano mediante ecografía y ecocardiografía fetal de estas entidades para guiar un diagnóstico y tratamiento oportunos(AU)

Introduction: Premature closure of the oval foramen or intrauterine restrictive oval foramen is a rare but serious clinical entity of unknown etiology. It can cause various heart defects, pulmonary hypertension, congestive heart failure, fetal hydrops and death. Diagnosis can be made by fetal echocardiography, although in most cases it occurs in postmortem autopsy. Objective: Describe the presentation of a case of fetal hydrops secondary to premature closure of the intrauterine oval foramen. Case presentation: A 34-week preterm newborn in which, in ultrasound and prenatal echocardiography, an increase in the cardiac chambers associated with intrauterine closure of oval foramen and hydrops was visualized; these findings were confirmed at birth. After a prolonged stay in the neonatal intensive care unit and treatment with inotropic and diuretic drugs, hospital discharge was granted with diagnosis of dilated cardiomyopathy secondary to restrictive oval foramen. Conclusions: The association of premature closure of oval foramen with fetal hydrops has been described in few publications and it is common in these the relation with perinatal death and extracardiac abnormalities. In this case, it is described hydrops secondary to the early closure of the intrauterine oval foramen that conditioned the overall dilation of heart chambers, and persistent severe ventricular dysfunction beyond the neonatal period without other associated abnormalities. Despite the severity of cardiovascular compromising, clinical evolution was favorable and allowed hospital discharge. Early recognition using ultrasound and fetal echocardiography of these entities is important to guide timely diagnosis and treatment(AU)

Tumor cardiaco fetal. Reporte de un caso / Fetal cardiac tumor. Report of a case

Resumen: ANTECEDENTES: Los tumores cardiacos fetales son excepcionales y se asocian con complicaciones que ponen en riesgo la vida del feto. Se diagnostican a partir del segundo trimestre y pueden provocar hidrops fetal no inmunitario, arritmias, compresión de los conductos de salida y muerte súbita. Es importante el seguimiento durante la gestación para detectar posibles complicaciones y establecer un plan de nacimiento. CASO CLÍNICO: Paciente de 35 años, multigesta, enviada a la unidad materno-fetal para valoración por embarazo de 24.2 semanas y feto con tumor cardiaco único, localizado en el ápex, de gran tamaño. No se identificó afectación de la función cardiaca, por lo que solo ameritó vigilancia prenatal. Al nacimiento, el recién nacido recibió tratamiento con everolimus, con reacción satisfactoria. CONCLUSION: El tratamiento y seguimiento de fetos con tumor cardiaco es de suma importancia para detectar complicaciones prenatales y establecer el plan de nacimiento en la unidad de tercer nivel de atención médica.

Abstract: BACKGROUND: Fetal cardiac tumors are rare, with a very low incidence, however; when they do occur, they are associated with life-threatening complications of the fetus. They are diagnosed from the second trimester and can cause non-immune fetal hydrops, arrhythmias, compression of outflow tracts, and sudden fetal death. Follow-up during pregnancy is important to detect possible complications and establish a birth plan. CLINICAL CASE: A 35-year-old multigest patient, sent to the fetal maternal unit by his treating physician for evaluation for 24.2-week pregnancy and fetus with a single cardiac tumor, located on the apex, of large size; and without compromise in cardiac function, so only prenatal surveillance was warranted. At birth, the newborn received everolimus treatment, with a good response. CONCLUSION: The case of a patient with a single pregnancy and fetus with a prenatal diagnosis of a large cardiac tumor is presented with a family history of hemangiomas. In this case, a follow-up approach to detect prenatal complications and establish a birth plan in a third level of medical care is critical for a good practice.

Hídrops fetal no inmunológico / Non-Immune Fetal Hydrops

El hídrops fetal se define como el acúmulo anormal de líquido en los tejidos blandos y cavidades serosas del feto (pleural, pericárdico y peritoneal). Se divide en dos grupos: hídrops fetal inmune e hídrops fetal no inmune. Se presenta el caso de gestante (9 semanas), calificada como riesgo genético incrementado por sus antecedentes obstétricos. Se procede según establece el Programa de Genética para la Detección Prenatal de Defectos Congénitos. Se resalta la importancia de la información de los resultados de las ecografías prenatales en el diagnóstico precoz de malformaciones congénitas y/o defectos estructurales del feto. Tras el seguimiento del caso y la realización de pruebas confirmativas se llegó al diagnóstico presuntivo de hídrops fetal no inmunológico, lo cual fue confirmado con posterioridad por anatomía patológica. Teniendo en cuenta que el pronóstico de esta entidad es generalmente desfavorable y con una tasa de mortalidad intrauterina muy alta, la pareja decidió la terminación del embarazo(AU)

serous cavities (pleural, pericardial, and peritoneal). It is divided into two groups: fetal immune hydrops and non-immune fetal hydrops. We report the case of a 9 weeks pregnant woman, classified to be at increased genetic risk by her obstetric history. We proceed as established by the Genetics Program for the Prenatal Detection of Birth Defects. The importance of the prenatal ultrasound information is relevant in the early diagnosis of congenital malformations and / or structural defects of the fetus. After the follow-up of the case and the performance of confirmatory tests, a presumptive nonimmunological fetal hydrops is diagnosed, which is subsequently confirmed by pathological anatomy. Taking into account that the prognosis of this entity is generally unfavorable and with very high intrauterine mortality rate, this couple decided to terminate the pregnancy(AU)

Síndrome en espejo como manifestación del desequilibrio angiogénico: Apropósito de un caso / The mirror syndrome as a manifestation of angiogenic imbalance: a propos of a case

El síndrome en espejo es una entidad obstétrica poco frecuente, cuya triada clásica es hidropesía fetal, edema materno generalizado y placentomegalia. Presentamos el caso de una gestante de 25 semanas, con diagnóstico de hidropesía fetal por anemia severa y criterios de preeclampsia severa con óbito fetal, en el contexto del síndrome en espejo. Revisamos la literatura con énfasis en la anti-angiogénesis como origen fisiopatológico de la enfermedad.

The mirror syndrome is a rare obstetric condition whose classical triad is fetal hydrops, generalized maternal edema and placentomegaly. We present the case of a 25 weeks pregnant woman with diagnosis of fetal hydrops due to severe anemia presenting criteria of severe preeclampsia with fetal death, in the context of mirror syndrome. We review the literature with emphasis on anti-angiogenesis as the pathophysiological origin of the disease.

Anticuerpos anti-Fya con reacción anamnésica asociada con anti-D en transfusión intrauterina: reporte de un caso / Anti-Fya antibodies with anamnestic reaction associated to anti-D in intrauterine transfusion: A case report

Resumen ANTECEDENTES La enfermedad hemolítica perinatal ocurre después de una transfusión sanguínea, que sensibiliza con antígenos eritrocitarios, hemorragia materno-fetal durante el embarazo o al momento del parto. La incidencia de anticuerpos anti-D ha disminuido de 14 a 0.1% en las madres D-negativas. No existe una inmunoglobulina que evite o disminuya la aloinmunización por otros antígenos eritrocitarios durante el embarazo. La incompatibilidad del grupo sanguíneo Duffy es una causa común de enfermedad hemolítica perinatal. OBJETIVO Exponer el caso de una paciente con hijo con enfermedad hemolítica perinatal por anticuerpos anti-Fya y anti-D tratado con transfusión intrauterina. CASO CLÍNICO Paciente de 22 años, con antecedente de múltiples transfusiones sanguíneas y datos clínicos de síndrome anémico. En la semana 28 del embarazo fue valorada para aplicarle inmunoglobulina anti-D. Luego de aplicarle dos unidades de concentrado eritrocitario Rh negativo se observó incompatibilidad (++) en fase de antiglobulina humana (Coombs), por esto se realizó el escrutinio de anticuerpos irregulares en gel, que resultó positivo en células I y II (+++). Enseguida se inició el protocolo de identificación de anticuerpos irregulares con un panel de 11 células, que reportó aglutinación en las células 1, 2, 3, 5, 6, 7, 8 y 11, sin mostrar especificidad. El estudio de adsorción del anticuerpo anti-D mostró células de antígeno D+ con las que se estableció el diagnóstico de anticuerpos anti-Fya y anti-D. El embarazo finalizó mediante cesárea con el nacimiento de un varón con grupo y Rh O positivo, de 30.1 semanas de gestación (talla de 40 cm y peso de 2000 g) con hidrops fetal. Se le realizaron ciclos de reanimación e ingresó a la unidad de cuidados intensivos neonatales, sin tratamiento farmacológico, y después de una hora de vida extrauterina falleció. La madre se dio de alta del hospital 36 horas después del puerperio, sin complicaciones adicionales. CONCLUSIÓN Los anticuerpos antieritrocitarios anti-Fya, solos o en combinación con otros anticuerpos, provocan enfermedad hemolítica perinatal severa. El laboratorio de inmunohematología tiene participación importante en el diagnóstico, seguimiento y tratamiento de la enfermedad hemolítica perinatal.

Abstract BACKGROUND Hemolytic disease of the fetus and newborn occurs after alloimmunization with red blood cells antigens by blood transfusion, maternal-fetal hemorrhage during pregnancy or at delivery. Currently, the incidence of alloimmunization by anti-D antibody has been reduced from 14% to 0.1% of D-negative mothers, however, there is no immunoglobulin that prevents or decreases alloimmunization by other red blood cells antigens during pregnancy. The incompatibilities of the Duffy blood group are a common cause of hemolytic disease of the fetus and newborn. OBJECTIVE To present the case of a neonate with perinatal hemolytic disease secondary to anti-Fya and anti-D antibodies managed with intrauterine transfusion. CLINICAL CASE A 22-year-old patient with a history of multiple blood transfusions and clinical data of anemic syndrome. In the 28th week of pregnancy it was evaluated for the application of anti-D immunoglobulin. The blood bank was asked for two units of Rh negative erythrocyte concentrate. Incompatibility (++) in the human antiglobulin phase (Coombs) was observed, so the irregular antibody gel was screened, which was positive in cells I and II (+++). An identification protocol for irregular antibodies was initiated with a panel of 11 cells, which reported agglutination in cells 1, 2, 3, 5, 6, 7, 8 and 11, without specificity. The adsorption study of the anti-D antibody showed D + antigen cells. The diagnosis of anti-Fya and anti-D antibodies was established. The pregnant woman was terminated by caesarean section, from which a male with a group was born and Rh O positive, of 30.1 weeks of gestation (size of 40 cm and weight of 2000 g) with fetal hydrops. He underwent resuscitation cycles, entered the neonatal intensive care unit, without pharmacotherapy and died after one hour of extrauterine life. The mother withdrew 36 hours after the puerperium, without additional complications. CONCLUSION The antibodies anti-Fya alone or next to other alloantibodies produce severe hemolytic disease of the fetus and newborn. The laboratory of immunohematology in the blood bank is an essential tool in the diagnosis, monitoring and treatment of hemolytic disease of the fetus and newborn.

Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: the fetus at risk for anemia: diagnosis and management

OBJECTIVE: We sought to provide evidence-based guidelines for the diagnosis and management of fetal anemia. METHODS: A systematic literature review was performed using MEDLINE, PubMed, EMBASE, and the Cochrane Library. The search was restricted to English-language articles published from 1966 through May 2014. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion. Evidence reports and published guidelines were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology was used for defining the strength of recommendations and rating the quality of evidence. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. RESULTS AND RECOMMENDATIONS: We recommend the following: (1) middle cerebral artery peak systolic velocity (MCA-PSV) measured by ultrasound Doppler interrogation be used as the primary technique to detect fetal anemia; (2) amniotic fluid delta OD450 not be used to diagnosis fetal anemia; (3) MCA-PSV assessment be reserved for those patients who are at risk of having an anemic fetus (proper technique for MCA-PSV evaluation includes assessment of the middle cerebral artery close to its origin, ideally at a zero degree angle without angle correction); (4) if a fetus is deemed at significant risk for severe fetal anemia (MCA greater than 1.5 multiples of the median or hydropic), fetal blood sampling be performed with preparation for an intrauterine transfusion, unless the pregnancy is at a gestational age when the risks associated with delivery are considered to be less than those associated with the procedure; (5) if a fetus is deemed at significant risk for severe fetal anemia, the patient be referred to a center with expertise in invasive fetal therapy; (6) MCA-PSV be considered to determine the timing of a second transfusion in fetuses with anemia, and, alternatively, a predicted decline in fetal hemoglobin may be used for timing the second procedure; and (7) pregnancies with a fetus at significant risk for fetal anemia be delivered at 37-38 weeks of gestation unless indications develop prior to this time.(AU)

Hidrotórax fetal primario: manejo antenatal / Fetal hydrothorax primary: handling antenatal

Hidrotórax fetal (HF) es la presencia de líquido en la cavidad pleural del tórax. Puede ser aislado o asociado con Hídrops y ascitis fetal. La incidencia 1:15.000 embarazos. Si es aislado, la causa más frecuente es quilotórax congénito, anomalía primaria del sistema linfático. En recién nacido (RN) es frecuente en el sexo masculino, primario y generalmente bilateral. En el feto, el secundario con prevalencia 1:1500 nacidos vivos y generalmente causado por isoinmunización, infecciones, cardiopatías, cromosomopatías, malformaciones de placenta y cordón umbilical. La edad promedio del diagnóstico son 27 semanas, reconociéndose ultrasonográficamente como un área anecoica alrededor de los pulmones. Su pronóstico depende fundamentalmente de la causa y secundariamente de su magnitud, lateralidad y presencia de hídrops. La mortalidad se estima en 25%, variando de 15% cuando es aislado y 95% asociado a hídrops. La mayoría, empeoran con el embarazo, haciéndose bilateral, puede genera compresión esofágica en Hidrotórax fetal primario (HFP) asociados a polihidramnios 72%. Se reporta caso de HFP, en paciente de 20 años con 25 semanas de gestación, cuyo hallazgo ultrasonográfico documenta derrame pleural derecho, se realiza toracocentesis intrauterina, obteniendo 25cc de líquido amarillento, posteriormente hay disminución del derrame pleural. Se obtuvo en cesárea segmentaria electiva a las 37 semanas + 6 días; RN femenino en estables condiciones generales, no requirió intubación ni soporte ventilatorio artificial. La evacuación intrauterina alivió la presión intratorácica, permitiendo una expansión satisfactoria de ambos pulmones y evitando la insuficiencia respiratoria del R.

Fetal hydrothorax (FH) is the presence of fluid in the pleural cavity of the chest. It may be isolated or associated with fetal hydrops and ascites. The incidence 1: 15,000 pregnancies If it is isolated, the most common cause is congenital chylothorax primary abnormality of the lymphatic system. In Newborn (RN) is common in males, usually bilateral primary and sex. In the fetus is secondary with prevalence 1: 1500 live births caused by isoimmunization, infections, heart disease, chromosomal abnormalities, malformations of placenta and umbilical cord. The average age of diagnosis is 27 weeks, ultrasonographically recognized as an anechoic area around the lungs. His prognosis mainly depends on the cause and secondarily of its size, laterality and presence of hydrops. The mortality is estimated at 25%, varying from 15% when it is isolated and 95% associated with hydrops. Most worsen bilateral becoming pregnancy can generate esophageal compression in primary fetal Hydrothorax (HFP) associated with polyhydramnios 72%. HFP case is reported, a patient of 20 years with 25 weeks of gestation, whose ultrasonographic finding documents right pleural effusion, intrauterine thoracentesis is done, obtaining 25cc yellowish liquid, then no decrease in the pleural effusion. It was obtained segmental elective Caesarean at 37 weeks + 6 days; Female RN in stable conditions did not require intubation or artificial ventilatory support. Intrauterine evacuation intrathoracic pressure relieved, allowing a satisfactory expansion of both lungs and respiratory distress avoiding RN.

Glycogen Storage Disease Presenting as Fetal Hydrops: A Case Report / 대한주산의학회잡지

Glycogen storage disease (GSD) is a group of heterogeneous disorders of glycogen metabolism that results in abnormal storage of glycogen in multiple organs. Clinical manifestations of GSD vary according to the basic enzyme defect. Only types II, IV, V or VII of GSD have been known to manifest in the infantile period. Of the 11 types of GSD, the congenital subtype of GSD type IV is characterized by severe neonatal hypotonia, multiple contractures, polyhydramnios, and fetal hydrops. We report a case of a patient born at a gestational age of 34 weeks and 3 days with fetal hydrops, joint contractures, and akinesia. Muscle biopsy results were highly indicative of GSD. This is the first case of suspected GSD in Korea presenting as fetal hydrops. The possibility of other disorders associated with glycogen metabolism should be considered in fatal fetal hydrops patients with severe hypotonia and arthrogryposis, and aggressive investigations such as muscle biopsy should be performed for early diagnosis.

Síndrome de Ballantyne (síndrome del espejo - mirror syndrome) / Ballantyne syndrome

Presentamos el caso de una gestante de 29 semanas que acude a urgencias por edemas en extremidades inferiores, un incremento ponderal en la última semana de 7 kg, oliguria y disnea. El feto presentaba un cuadro de ascitis y edema subcutáneo. Se realizó el diagnóstico de hidrops fetal no inmune, en el contexto de un síndrome de Ballantyne de causa desconocida. Inició trabajo de parto a los 7 días del ingreso y el puerperio cursó sin incidencias siendo dada de alta a las 48 horas post parto. El neonato precisó soporte respiratorio con ventilación no invasiva durante dos semanas y actualmente sigue controles periódicos en neonatología, con muy buena evolución.

We report a case of a 29 weeks pregnant who came to the emergency department because she presented oedema in lower extremity, weight increased in the last week of 7 kg, oliguria and dyspnoea. The fetus showed ascites and subcutaneous oedema. It was diagnosed a non-immune hydrops, in the context of Ballantyne syndrome of unknown cause. Childbirth was 7 days after admission and puerperium envolved normally, the patient was discharged at 48 hours postpartum. The neonate required respiratory support with non-invasive ventilation for two weeks and nowadays the baby is currently regular checks in neonatology, with a positive evolution.

Hidropesía fetal como signo ecográfico de toxoplasmosis congénita

El presente caso comunica un signo ecográfico poco frecuente de toxoplasmosis congénita, la hidropesía fetal como única manifestación del compromiso fetal. El diagnóstico definitivo se realizó en el recién nacido, quien presentó hepatoesplenomegalia, coriorretinitis y ausencia de calcificaciones cerebrales, siendo la serología positiva para toxoplasmosis, tanto para la madre como al recién nacido.

This case reports a rare ultrasonographic sign of congenital toxoplasmosis, fetal hydrops, as the only manifestation of fetal compromise. Definitive diagnosis was done in the newborn who presented hepatosplenomegaly, chorioretinitis and absence of cerebral calcifications, being both mother and newborn positive for toxoplasmosis serology.

Diagnóstico prenatal de hidrops fetal no inmune. Serie de nueve casos. Revisión de la literatura / Prenatal diagnosis of non-immune fetal hydrops: a series of nine cases and a literature review

Objetivo: se presenta una serie de casos de hidrops fetal no inmune (HFNI) con el objetivo de revisar la literatura sobre su etiología y pronóstico. Materiales y métodos: serie de casos diagnosticados por ultrasonografía en el Servicio de Perinatología del Hospital Dr. Adolfo Prince Lara, Venezuela, hospital público de referencia de atención perinatal regional que atiende población de medios y bajos ingresos, en el periodo 2005-2009, y se realiza una revisión de la literatura en la base de datos Medline vía Pubmed, y en la base latinoamericana SciELO desde el año 1995 hasta 2011, y en libros de la especialidad. La palabra clave usada fue hidrops fetal. Resultados: se revisaron 2195 historias clínicas encontrándose nueve casos de HFNI, resultando una prevalencia de (0,41 por ciento). Hubo dos casos de monosomías, un caso asociado a proceso infeccioso, dos casos de malformaciones cardiacas, un caso de malformaciones múltiples, y en tres no se precisó etiología. Todos los productos fallecieron, ya sea in utero o en el periodo neonatal. Se encontraron 1584 publicaciones, incluyéndose 14 referencias, 6 revisiones, 6 presentaciones de casos y 2 artículos originales. Conclusión: HFNI está asociado a diversas patologías fetales y tiene alta mortalidad.

Objective: A series of cases of non-immune fetal hydrops (NIFH) is presented, aimed at reviewing the literature concerning its etiology and prognosis. Materials and methods: A series of cases diagnosed by ultrasonography at the Dr. Adolfo Prince Lara Hospital Perinatology Service in Venezuela, 20052009, is presented; this is a public reference hospital providing regional perinatal attention for the poorest strata of the population. A literature review was made using the Medline database via PubMed and the SciELO Latin-American database from 1995 to 2011, and in specialized books on the topic. Fetal hydrops was the key word used in the search. Results: 2,195 clinical histories were reviewed, finding 9 cases of NIFH (0.41 percent prevalence). There were two cases of monosomy, one infectionassociated case, two cases of cardiac malformation, a case of multiple malformations and etiology was not specified in three cases. Death occurred in all cases, whether in the uterus or during the neonatal period. 1,584 publications were found, including 14 references, 6 reviews, 6 case presentations and 2 original articles. Conclusion: NIFH is associated with differing fetal pathologies and involves high mortality.

Leucemia fetal congénita como causa de hidropesía fetal: diagnóstico y curso perinatal

Se comunica un caso de leucemia en un feto de 31 semanas que cursó con anemia severa, hidropesía y muerte intraútero. La evaluación sonográfica fetal mostró hidropesía severa con anemia cuantificada por Doppler de la arteria cerebral media. Se evidenció además visceromegalia y riñones aumentados de tamaño, con patrones que impresionaban como displasia renal. El feto falleció antes de poder completar otras pruebas diagnósticas. Se tuvo que inducir el parto vaginal, luego de lo cual se realizó necropsia del producto. Las pruebas histológicas post mórtem permitieron el diagnóstico de leucemia fetal.

A case of leukemia in a 31-week fetus with severe anemia, hydrops and intrauterine death is reported. Ultrasound evaluation showed severe hydrops and anemia quantified by Doppler of the medial cerebral artery, as well as visceromegaly and renal enlargement with signs of dysplasia. There was fetal demise before other diagnostic tests could be performed. Labor was induced. Post mortem examination of the product determined fetal leukemia.

Hidrops fetal no inmune por anemia diseritropoyética congénita / Nonimmune hydrops fetalis by congenital dyserythropoietic anaemia

La anemia diseritropoyética congénita se engloba dentro de un grupo raro y heterogéneo de trastornos eritrocitarios caracterizados por eritropoyesis ineficaz, anemia megaloblástica, hemosiderosis secundaria e hidrops fetal. Presentamos el caso de un feto de 20 semanas con hidrops como consecuencia de una anemia fetal intensa por eritropoyesis ineficaz. Ante el hallazgo de hidrops fetal no inmune es fundamental un diagnóstico etiológico precoz para ofrecer a la pareja las alternativas terapéuticas más adecuadas.

Congenital dyserythropoietic anemia is a rare group of heterogeneous disorders characterized by ineffective erythropoiesis, megaloblastic anemia, secondary hemosiderosis and fetal hydrops. We report a case of a 20 week old fetus with hydrops as a consequence of a severe fetal anemia resulting from ineffective erythropoiesis. When non-immune fetal hydrops is found, it is essential an early etiological diagnosis to give the parents the most appropriate therapeutic options.