Fetal ascites caused by intraabdominal bleeding and secondary fetal anaemia treated by intrauterine blood transfusion (IUT) in the gestional age of 28 weeks

Purpose: Fetal ascites refers to the accumulation of free fluid in the fetal abdomen. After the recognition of ascites in antenatal ultrasound, it is essential to establish whether this is an isolated fetal ascites or associated with hydrops.

Methods: A 30-year-old woman (G II P 0, 27 + 4. SSW) was admitted for generalised pruritus and sonographically diagnosed isolated fetal ascites.

Results: The mother was blood group A and Rh positive. The praenatal organ screening was without pathological findings. Further we diagnosed a intrahepatic cholestasis of pregnancy (ICP) with a enormously level of bile acids (160 µmol/l). Antenatal TORCH, HIV, Treponema and Hepatitis screening were all normal. Fetal MRI detected no ohter organic abnormalities. The isolated intraabdominal ascites can be caused by blood or meconium. Intermittently the peak systolic velocity of the MCA was pathological. In the further course the fetus presents a suspect fetal heart rate. In a gestational age of 29 weeks, under the suspicion of intraabdominal bleeding we admitted the patient to the UKH for intrauterin blood tranfusion (IUT). The concentration of foetal haemoglobin was determined in umbilical cord blood before (9 g/dl) and after (15.8 g/dl) the IUT. 105 ml of red blood cell concentrate were transfused. In the gestional age of 37 weeks our patient was born by secondary lower segment Cesarean section due to fetal distress (APGAR 8 – 8 – 9, pHUA 7.29, 2750 g, 45 cm). Under suspicion of ileus one day after birth the explorative laparotomy was performed. Intraoperativ the newborn developed a pulmonary hypertension, the operation had to interrupted. In a second look laparotomy an atresia of jejunum with perforation and meconium peritonitis were detected.

Conclusion: Fetal ascites can result from many different aetiologies, including gastrointestinal and genitourinary anomalies. Chromosomal abnormalities and viral aetiologies must also be considered.