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NONIMMUNE HYDROPS FETALIS: UNRAVELING THE ETIOLOGY
AND CLINICAL IMPLICATIONS
Pulatova G.A.
Yusupbaev R.B.
Republican specialized scientific and practical medical center for maternal and
child health. Tashkent. Uzbekistan.
https://doi.org/10.5281/zenodo.13683212
Advances in prenatal imaging have led to earlier and more frequent
diagnoses of NIHF, making it a critical area of study for obstetricians and
pediatricians. NIHF can result from a variety of underlying conditions, including
cardiovascular anomalies, chromosomal abnormalities, infections, and metabolic
disorders. Understanding these diverse causes is essential for effective
management and counseling. The prognosis for fetuses with NIHF varies widely
based on the underlying cause. Research into prognostic factors can inform
clinical decision-making and improve outcomes for affected infants. Emerging
therapies, such as fetal interventions and improved prenatal care strategies, are
being developed to manage NIHF more effectively, highlighting the need for
ongoing research.
Non-immune hydrops fetalis is recognized as a complex polyetiological
disease that can be caused by more than 150 different conditions. Despite the
wide variety of causes, in 18% of cases it is not possible to determine the specific
etiological factor of the disease [2].
With non-immune fetal hydrops, the miscarriage and stillbirth rate reaches
95%. The prognosis is unfavorable, but the cause of the disease and the time of
onset of symptoms play an important role [1,5].
All of the above allows us to think that a clear definition of the management
of patients with non-immune hydrops fetalis makes the presented problem
extremely relevant and promising.
The objective of this study
is to examine and analyze the medical histories
of patients diagnosed with nonimmune hydrops fetalis.
Materials and Methods:
This study involved both retrospective and
prospective analyses. The retrospective component gathered data on the annual
incidence of nonimmune hydrops fetalis (NHF), its causes, and patient outcomes.
To align with the study's aims, participants in the prospective analysis were
categorized into two groups: Group 1 included 20 pregnant women with NHF
who underwent intrauterine treatment methods, while Group 2 comprised 22
pregnant women with NHF who opted out of treatment.
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Results.
The causes of the disease were identified in 59% of cases in the
retrospective group and in 86.2% in the prospective group. Chromosomal
abnormalities were found in 9 patients, with trisomy 21 being the most
prevalent. All chromosomal abnormalities were detected during the first half of
pregnancy, indicating that nonimmune hydrops fetalis occurring early on is
frequently associated with aneuploidy.
Another significant cause of nonimmune hydrops fetalis identified in the
study was cardiovascular system pathology, with 57.1% of these cases
exhibiting tachyarrhythmias. A comprehensive treatment regimen for
nonimmune hydrops fetalis related to tachyarrhythmias was established, and all
cases of tachyarrhythmias were found to be treatable.
In pregnant women who adopted an active approach, conservative
therapies included antiviral treatments, immunoglobulin infusions, cardiotonic
therapy, and antibacterial methods. Notably, immunoglobulin infusion was
utilized for the first time in cases of nonimmune hydrops fetalis, yielding
effective results in 7 out of 9 patients.
The study also reported that 55% of fetal surgical procedures, such as fetal
paracentesis, thoracocentesis, and amnioreduction, were performed. The serous
fluids obtained were analyzed in the laboratory, which informed subsequent
treatment strategies.
In the next phase, pregnancy outcomes were evaluated. Among the
participants, 27.4% delivered living children, all of whom were from Group 1,
where active interventions were employed. During the period between 37 and
41 weeks, 45% of births occurred in Group 1, whereas no births were recorded
in Group 2 during this timeframe (p < 0.001).
Conclusion.
If active management is chosen and intrauterine treatment of the
fetus is used, pregnancy with non-immune hydrops fetalis should be prolonged
for as long as possible, preferably until full-term pregnancy. Preterm birth with
nonimmune hydrops fetalis does not improve perinatal outcomes.
References:
1.
Бец О.Г., Хмелевская И.Г., Серёжкина А.В., Булка А.А., Ходулапова Л.Г.,
Являнская
О.С.
Клинический
случай
неиммунной
водянки
у
недоношенного ребенка с наличием IgG к SARS-СоV-2 при рождении.
Человек и его здоровье. 2022;25(2):4-12. DOI: 10.21626/vestnik/2022-2/01
2.
Beth M. Kline-Fath., Dorothy I. Bulas, Ray Bahado-Singh. Fundamental and
advanced fetal imaging : ultrasound and MRI -2015- Р. 803-822
ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
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3.
Kilby M., Johnson A., Oepkes D. (Eds.) Fetal Therapy: Scientific Basis and
Critical Appraisal of Clinical Benefits. 2nd edition. — Cambridge University
Press, 2020. — 624 p. — ISBN: 978-1-108-47406-1.
4.
Pulatova G.A., Yusupbaev R.B. Diagnosis, Management and Outcomes of
Non-Immune Hydrops Fetalis in Uzbekistan. American Journal of Medicine and
Medical
Sciences,
Vol.
13
No.
2,
2023,
pp.
170-175.
doi:
10.5923/j.ajmms.20231302.30.
5.
Pulatova G.A. et al. Diagnostic algorithm for non-immune hydrops fetalis.
New Day in Medicine. 8(46)2022;8(46):64-68 https://clck.ru/sTAch
