Fetal anasarca, defined by the presence of generalized subcutaneous edema measuring >5 mm tissue thickness, is a rare sonographic finding associated with end-stage hydrops fetalis and impending fetal death.This literature review describes the etiology, diagnosis, treatment, and prognosis for both immune and nonimmune hydrops fetalis. Medical technology and treatment have favorably affected fetal mortality associated with hydrops fetalis. Sonography is a noninvasive procedure that is heavily used in the management of hydrops fetalis. Sonographic guidance is equally important in the diagnosis and treatment. Sonographer recognition of early signs that may precipitate fetal anasarca is vital to continued favorable maternofetal outcome.
Stedman’s Medical Dictionary. 27th ed. Baltimore, MD, Lippincott Williams & Wilkins, 2000.
2.
Abraham D., Greenhut WM, Koenigsberg M.: The effect of maternal disease on pregnancy, in Berman MC, Cohen HL (eds): Diagnostic Medical Sonography Obstetrics and Gynecology. 2nd ed. Philadelphia , Lippincott Williams & Wilkins, 1997, pp 517-532.
3.
Wilkins I: Nonimmune hydrops , in Creasy RK, Resnik R (eds): Maternal-Fetal Medicine. 4th ed. Philadelphia, W. B. Saunders , 1999, pp 769-782.
4.
Mitchell C., Trampe B.: Ultrasound and high risk pregnancy, in Hagen-Ansert SL (ed): Textbook of Diagnostic Ultrasonography . 6th ed. St. Louis, MO, Mosby Elsevier, 2006, pp 1086-1106.
5.
Fleisher AC, Killam AP, Boehm FH, et al: Hydrops fetalis: Sonographic evaluation and clinical implications . Radiology1981;141:163-168.
6.
Potter EL, Craig JM: Pathology of the Fetus and the Infant. 3rd ed. Chicago, Year Book Medical Publishers , 1975.
7.
Sohaey R.: Hydrops, in Woodward PJ (ed): Diagnostic Imaging: Obstetrics. Salt Lake City, UT, Amirsys, 2005, pp 17/32-17/35.
8.
Chinn DH: Ultrasound evaluation of hydrops fetalis, in Callen PW (ed): Ultrasonography in Obstetrics and Gynecology. 3rd ed. Philadelphia, W. B. Saunders, 1994, pp 420-439.
9.
Cook VD, Shah DM: Second and third trimester ultrasound evaluation, in Dogra V, Rubens DJ (eds): Ultrasound Secrets. Philadelphia , Hanley & Belfus, 2004, pp 52-66.
10.
Smith-Weaver M.: Second-trimester findings associated with nonimmune hydrops. J Diagn Med Sonography2008;24:93-96.
11.
Morrison SC , Bryan PJ, Jassani MN: Perinatal ultrasound in erythroblastosis fetalis, in Fanaroff AA, Martin RJ (eds): Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 5th ed. St. Louis, MO, Mosby Year Book, 1992, pp 80-99.
12.
Ballantyne JW : Diseases and Deformities of the Fetus. Edinburgh, UK, Oliver & Boyd, 1892.
13.
Levine P., Burnham L., Katzin EM, Vogel P.: The role of iso-immunization in the pathogenesis of erythroblastosis fetalis . Am J Obstet Gynecol1941;42:925-937.
14.
Levine P., Stetson RE: An unusual case of intra-group agglutination. JAMA1939;113:126-127.
15.
Queenan JT: Erythroblastosis fetalis, in Fanaroff AA, Martin RJ (eds): Neonatal Perinatal Medicine: Diseases of the Fetus and Infant. 5th ed. St. Louis, MO, Mosby Year Book, 1992, pp 235-243.
16.
Landsteiner K., Weiner AS: An agglutinable factor in human blood recognized by immune sera for Rhesus blood. Proc Soc Exp Biol Med1940;43:223-224.
17.
Potter EL: Universal edema of the fetus unassociated with erythroblastosis. Am J Obstet Gynecol1943;46:130-134.
18.
Bowman JM: Hemolytic disease, in Creasy RK, Resnik R (eds): Maternal-Fetal Medicine. 4th ed. Philadelphia, W. B. Saunders, 1999, pp 736-768.
19.
Sherer DM, Abramowicz JS, Ryan RM, et al: Severe fetal hydrops resulting from ABO incompatability. Obstet Gynecol1991;78:897-899.
20.
Smoleniec CP , James D.: Fetal hydrops-is the prognosis always poor ? J Obstet Gynaecol1994;14(3):142-145.
21.
Wy DA, Sajous CH, Loberiza F., Weiss MG: Outcome of infants with a diagnosis of hydrops fetalis in the 1990’s . Am J Perinatol1999;16:561-567.
22.
Smoleniec CP , Weiner CP, James D.: Fetal hydrops, in James DK, Steer PH, Weiner CP, Gonik B (eds): High Risk Pregnancy. Philadelphia , W. B. Saunders, 1999, pp 327-342.
23.
Friedman AH , Copel JA, Kleinman CS: Fetal echocardiography in the diagnosis and management of fetal structural heart disease and arrhythmias, in Reed GB, Claireaux AE, Cockburn F (eds): Diseases of the Fetus and Newborn. 2nd ed. London, Chapman & Hall, 1995 , pp 955-970.
24.
Ryan G., Whittle MJ: Immune and non-immune fetal hydrops, in Reed GB, Claireaux AE, Cockburn F (eds): Diseases of the Fetus and Newborn. 2nd ed. London, Chapman & Hall, 1995, pp 1257-1265.
25.
Avni EF, Vanderelst A., Van Gansbeke D., Schils J., Rodesch F.: Antenatal diagnosis of pulmonary tumours: report of two cases. Pediatr Radiol1986;16:190-192.
26.
Bailao LA, Rizzi MCS, Bonilla-Musoles F., Osborne NG: Ultrasound markers of fetal infection: an update. Ultrasound Q2000;16(4):221-233.
27.
Zeltser I., Parness IA, Ko H., Holzman IR, Kamenir SA: Midaortic syndrome in a fetus and premature newborn: a new etiology of nonimmune hydrops fetalis and reversible fetal cardiomyopathy. Pediatrics2003;111(6):1437-1442.
28.
Bhattacharya B., Cohchran E., Loew J.: Pathology quiz case: a 27-week female fetus with massive macrocephaly and generalized anasarca . Arch Pathol Lab Med2004;128:102-104.
29.
Rheuban KS, McDaniel NL, Feldman PS, Mayes DC, Rodgers BM: Intrapericardial teratoma causing nonimmune hydrops fetalis and pericardial tamponade: a case report. Pediatr Cardiol1991;12:54-56.
30.
Nassenstein K., Schweiger B., Barkhausen J.: Prenatal diagnosis of anasarca in an end-second trimester fetus presenting with sacrococcygeal teratoma by magnetic resonance imaging. Magn Reson Imaging2006;24:977-978.
31.
Herman TE: Antenatal-onset infantile cortical hyperostosis and nonimmune hydrops . J Perinatol1996;16(2):137-139.
32.
Has R.: Non-immune hydrops fetalis in the first trimester: a review of cases . Clin Exp Obstet Gynecol2002;28(3):187-190.
33.
Ram SP, Ariffin WA, Kassim Z.: Case report: a neonate with nonimmune hydrops fetalis. Singapore Med J1993;34: 459-461.
34.
Machin GA: Hydrops revisited: literature review of 1,414 cases published in the 1980s . Am J Med Genet1989;34: 366-390.
35.
Humphrey W. , Magoon M., O’Shaughnessy R.: Severe nonimmune hydrops secondary to parvovirus B-19 infection: spontaneous reversal in utero and survival of a term infant. Obstet Gynecol1991;78:900-902.
36.
Mostello DJ , Bofinger MK, Siddigi TA: Spontaneous resolution of fetal cystic hygroma and hydrops in Turner’s syndrome. Obstet Gynecol1989;73:862-865.
37.
Robertson L. , Ott A., Mack L., Brown ZA: Sonographically documented disappearance of non-immune hydrops fetalis associated with maternal hypertension. West J Med1985 ;143:382-383.
38.
Shapiro T., Scharf M.: Spontaneous intrauterine remission of hydrops fetalis in one identical twin: sonographic diagnosis. J Clin Ultrasound1985 ;13:427-430.
39.
Gillan JE: Intrapartum Events, in Reed GB , Claireaux AE, Cockburn F (eds): Diseases of the Fetus and Newborn. 2nd ed. London, Chapman & Hall, 1995, pp 285-318.
40.
Castillo RA , DeVope LD, Hadi HA, Martin S., Geist D.: Nonimmune hydrops fetalis: clinical experience and factors related to poor outcome. Am J Obstet Gynecol1986;155:812-816.
41.
Favre R., Dreux S., Dommergues M., et al: Nonimmune fetal ascites: a series of 79 cases. Am J Obstet Gynecol2004;190:407-412.
42.
Rodeck CH, Fisk NM, Fraser DI, Nicolini U.: Long-term in utero drainage of fetal hydrothorax. N Engl J Med1988;319:1135-1138.
43.
Bourget P., Pons J., Delouis C., Fermont L., Frydman R.: Flecainide distribution, transplacental passage, and accumulation in the amniotic fluid during the third trimester of pregnancy. Ann Pharmacother1994;28:1031-1034.
44.
Morel O., Chagnaud S., Laperrelle J., et al: Parvovirus B19 in pregnancy: literature review. Gynecol Obstet Fertil2007;35(11):1095-1104.
45.
Nagel HT, de Haan TR, Vanderbussche FP, Oepkes D., Walther FJ: Long-term outcome after fetal transfusion for hydrops associated with parvovirus B19 infection. Obstet Gynecol2007;109(1):42-47.
46.
Bullock R., Martin WL, Coomarasamy A., Kilby MD: Prediction of fetal anemia in pregnancies with red-cell alloimmunization: comparison of middle cerebral artery peak systolic velocity and amniotic fluid OD450. Ultrasound Obstet Gynecol2005;25(4):331-334.
47.
Mari G.: Middle cerebral artery peak systolic velocity: is it the standard of care for the diagnosis of fetal anemia?J Ultrasound Med2005;24(5):697-702.
48.
Trainor B., Tubman R.: The emerging pattern of hydrops fetalis: incidence, aetiology and management . Ulster Med J. 2006;75(3):185-186.
49.
Machado LE, Osborne NG, Bonilla-Musoles F.: Two-dimensional and three-dimensional ultrasound of fetal anasarca: the glass baby. J Perinat Med2002;30:105-110.
50.
Paternoster DM, Manganelli F., Minucci D., et al: Ballantyne syndrome: a case report . Fetal Diagn Ther2006;21:92-95.
