Hydrops Fetalis Caused by Fetal Structural Malformation in the Second Trimester of Pregnancy with Vaginal Bleeding: A Case Report

Abstract

Background: Hydrops fetalis is a severe fetal condition characterised by abnormal fluid accumulation in at least two fetal compartments, including the pleural, pericardial, or peritoneal spaces, with or without subcutaneous oedema. Non-immune hydrops fetalis accounts for most reported cases and is associated with poor perinatal outcomes, particularly when diagnosed early in gestation. Aim: The case report presents the clinical presentation, antenatal findings, diagnostic evaluation, and obstetric management of a pregnant woman diagnosed with hydrops fetalis, and highlights the associated maternal and fetal outcomes. Case Presentation: A 28-year-old gravida 2 woman at 19–20 weeks of gestation presented with recurrent abdominal tightening, decreased fetal movement, and vaginal bleeding. Obstetric ultrasonography demonstrated generalised fetal fluid accumulation consistent with hydrops fetalis. Maternal laboratory evaluation revealed mild anaemia. Due to worsening clinical condition and severe fetal compromise, emergency pregnancy termination by cesarean section was performed. A fetus with hydrops fetalis weighing 1400 grams was delivered with an Apgar score of 1, indicating profound fetal distress. The surgical procedure was completed without maternal complications, and placental delivery occurred spontaneously. Conclusion: Early-onset hydrops fetalis before fetal viability carries a grave prognosis and a high risk of fetal death. Prompt recognition, maternal stabilisation, and systematic diagnostic evaluation are essential to guide management, identify potential underlying causes, and provide counselling regarding future pregnancy risks.