Condition in which the placenta is enlarged (dm,mp,hydrops)
Answers
PMD is characterised by ultrasound and clinical features of gross placentomegaly with grape-like vesicles and vascular anomalies.1 Reported in the literature as ‘placentomegaly with massive hydrops of placental stem villi’ and ‘pseudopartial mole’, PMD is often misdiagnosed as partial mole, dichorionic twin pregnancy with normal fetus and coexisting complete hydatidiform mole, placental mosaicism and placental chorioangiomas.1–4
However, while partial hydatiform mole is almost never associated with a structurally normal fetus and has trophoblastic proliferation and stromal trophoblastic inclusions on pathological analysis, the fetus may be normal in majority of cases of PMD, with no trophoblastic proliferation or evidence of trophoblastic disease or recurrence.1 4 In complete mole with coexistent fetus, the abnormal fetal vessels in the stem villi characteristic of PMD are absent even though the fetus has a diploid karyotype.1 5 An early ultrasound with two gestational sacs and high-velocity low-impedance flow in the molar placental tissue may support this diagnosis of complete mole with coexistent fetus.4
Cystic villi on ultrasound have also been reported with confined placental mosaicism with trisomy 16 and can be diagnosed by karyotype of placenta and newborn.1 Placental chorioangioma, subchorionic haematoma, infarcts and spontaneous abortion with hydropic changes are other conditions that simulate PMD on ultrasound.4 Spontaneous abortion is characterised by degenerative changes on histology and small vesicles that are focal rather than diffuse in contrast to PMD.4 Placental chorioangioma has a well-circumscribed echogenic area with increased vascularity which may be seen as a protrusion on the fetal placental surface.6 This increased flow may lead to fetal congestive heart failure. In contrast to chorioangioma and molar pregnancy, PMD has absent or low venous signals inside the placenta, in the first and second trimesters.4 Jauniaux et al7 showed that there was no association between size of placenta and fetal salvagability in PMD.
A careful ultrasound assessment of fetal structure, growth and karyotype is warranted. The fetus may be normal in karyotype and phenotype in most cases of PMD.1 Though growth restriction may be associated with 50% of cases of PMD, macrosomia may suggest Beckwith-Wiedemann syndrome (BWS). Various characteristics of placenta and Doppler flow, as mentioned above, may differentiate PMD from causes of placentomegaly with cystic spaces in the placenta. Postnatally, clinical examination of the placenta and baby, histopathology of the placenta and karyotype of the fetus and placenta is helpful to confirm the diagnosis.
Explanation:
This type of hydrops is not very common. It may develop because of Rh disease in the mother. If you are Rh negative and have an Rh positive baby, your immune system attacks your unborn baby’s red blood cells. This causes anemia. Hydrops can occur if the developing baby's organs can't overcome the anemia. The heart starts to fail. Large amounts of fluid build up in the baby's tissues and organs. This type of hydrops is not common today because Rh negative women are usually treated with Rh immunoglobulin to prevent this problem.
Nonimmune hydrops
This is the more common type of hydrops. This type includes all other diseases or complications that may interfere with how your baby manages fluid. Some of the diseases or conditions that can cause nonimmune hydrops include:
Severe anemia
Infections present before birth
Heart or lung defects
Chromosomal abnormalities and birth defects
Liver disease
What are the symptoms of hydrops fetalis?
Symptoms can occur a bit differently in each child. Below are the most common symptoms of hydrops.
During pregnancy, symptoms may include:
Large amounts of amniotic fluid
Thickened placenta
Ultrasound of the unborn baby that shows enlarged liver, spleen, or heart. It may show a fluid buildup around the baby’s abdominal organs, heart, or lungs.
After birth, symptoms may include:
Pale coloring
Severe swelling overall, especially in the baby's belly (abdomen)
Trouble breathing
Enlarged liver and spleen
The symptoms of hydrops may look like other health conditions. It is almost always diagnosed during pregnancy or immediately at birth.
How is hydrops fetalis diagnosed?
Before birth your baby may need these tests:
Ultrasound.This test uses sound waves to create images of blood vessels, tissues, and organs. The healthcare provider will use the ultrasound to look at how your baby's internal organs are working. The provider can see how blood flows through different vessels.
Fetal blood sampling. This is done by placing a needle through your uterus and into 1 of your baby’s blood vessels or the umbilical cord.
Amniocentesis. This test is done by removing some of the amniotic fluid around your baby for testing.
How is hydrops fetalis treated?
Treatment of hydrops depends on the cause. During pregnancy, hydrops may be treatable only in certain cases. You may need to deliver your baby early. In a newborn baby, treatment may include:
Help for breathing problems. This may be with extra oxygen or a breathing machine (ventilator)
Removing extra fluid from spaces around the lungs, heart, or inside the belly using a needle
What are possible complications of hydrops fetalis?
The severe swelling that occurs with hydrops can overwhelm the baby's organ systems. About 50% of unborn babies with hydrops don’t survive. Risks for other problems are also high for babies born with hydrops. Survival often depends on the cause and treatment.
Key points about hydrops fetalis
Hydrops fetalis is severe swelling (edema) in an unborn baby or a newborn baby. It is a life-threatening problem.
Hydrops develops when too much fluid leaves the baby's bloodstream and goes into the tissues.
Treatment of hydrops depends on the cause.
About 50% of unborn babies with hydrops don’t survive.
Next steps
Tips to help you get the most from a visit to your child’s healthcare provider:
Know the reason for the visit and what you want to happen.
Before your visit, write down questions you want answered.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
Ask if your child’s condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if your child does not take the medicine or have the test or procedure.
If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
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