Etiology of Hydrops Fetalis at the Philippine General Hospital: A Retrospective Study

Michelle E. Abadingo and Maria Melanie Liberty B. Alcausin

Department of Pediatrics, College of Medicine and
Philippine General Hospital, University of the Philippines Manila

Objective. Hydrops fetalis (HF) is a diagnosis with significant morbidity and mortality. It is the objective of this study to identify common etiologic causes of HF in the Philippine General Hospital (PGH).

Methods. This is a retrospective review of hydrops fetalis cases delivered at the PGH from 2010 to 2014. There was a total of 75 identified cases of hydrops fetalis. However, only 58 of these, or 77.33% have available medical charts for review.

Results. The median gestational age at birth was 31 (range 21-40) weeks. There were 19 identified cases (32%) of stillbirth. Of the 32 patients born alive, 30 (93.75%) died in the immediate neonatal period. The etiologies of HF were identified in 15 cases, which included congenital anomalies (n=4), cardiac anomalies (n=3), infectious problems (n=3), hematologic anomalies (n=2), placental anomalies (n=2) and congenital tumor (n=1). Cases of congenital anomalies were only detected by congenital anomaly scan; no further work-ups were done. Fifteen (15) mothers presented with microcytic, hypochromic anemia on complete blood count (CBC). The cause of HF was not confirmed in the remaining 43 (74%) cases.

Conclusion. It is important to fully investigate the causes of HF to aid in the proper management and counseling. Further work-up must be done for mothers presenting with microcytic, hypochromic anemia. This is an important feature of alpha thalassemia. Partners of women suspected to have alpha thalassemia should also have a hematologic screening. The deletion of the four alpha genes will result to HB Bart’s hydrops fetalis; a major cause of hydrops fetalis in Southeast Asian countries.

Key Words: Hydrops fetalis, etiology, fetal outcome