Non immune Hydrops foetalis.

What are the tests to be done in cases of NIH-Non immune hydrops ?

It is a challenge for the obstetricians to find the cause of previous NIH. Because varieties of costly tests have to be done to arrive at a definitive diagnosis which are quite costly? In short the common causes are 1) Karyotyping abnormality of foetus 30-50% cases. 2) Cardio Vascular defects – about 25% cases particularly which cause rise of Rt. Atrial pressure, = premature closure F Ovale/ D Arteroisus, . In fact many septal abnormalities & Fallots can yield to NIH. 3)  In 10-15% cases there can be genetic disorders which are difficult to diagnose. Additionally abnormalities of foetal thoracic contents may lead to NIH.

Prepregnancy planning & Investigations suggested.-

1)History of couple:-Any past / present medical disease, drug abuse causing mutagenesis. / working place pollutes to affect DNA integration/ impaired oogenesis?

2)H/o/ Viral infection in past preg/ Family of H/O any metabolic disease/ Genetic disease in wife/husband. Any Diabetes?

3)Tests in interval period prior to next pregnancy:- Blood –complete haemogram, ABO Rh, Antibody screen, HPLC, Infection Screen to have a basal IGG & IgM level(this may be compared later in pregnancy that will follow- Avidity Tests if facilities are available).- This include Rubella, CMV, Parvovirus B-19, & treponoma serology. Additionally OGTT and Autoantibody screen should be done (LA, tests for SLE).

Suggested investigations during pregnancy which follows after a Hydrops (as suggested by Swain et al, 1999=Aust N Z J Obstet Gyaecol 1999; 39:285-90.

If previously quoted tests are not carried out then above quoted test may be ordered.

Additionally chromosomal markers as is done in first and second trimester screening should be done at 12-13 weeks & at 15 weeks both in sera & USG (Searching for soft markers).

What is relevant is to bestow on Foetal Blood sampling: - a) Karyotype, b) Total Ig M. c) Blood group & COOMBS TEST   D) Viral Screen –But some are of opinion that amniocentesis will be more judicious choice because that will offer an option of not only foetal karyotype but also testing for viral and bacterial culture and give a chance for excluding metabolic dis orders.  Parvovirus B-19, CMV, Rubella E) Toxo F)   Full blood count G) Detailed Anomaly Scan , Doppler studies & Placental morphology. H) Foetal Echo, & Foetal cardiac biometry

In fact there is a well written chapter on NIH in the book titled “Foetal Medicine: Basic Science and Clinical Practice. Ed. Rodeck CH, Whittle MJ, London Churchill Livingstone m 2008.