Do abnormal Starling forces cause fetal hydrops in red blood cell alloimmunization?

      This paper is only available as a PDF. To read, Please Download here.
      OBJECTIVE: The purpose of the current investigation was to ascertain whether derangements in umbilical venous pressure and plasma colloid osmotic pressure are involved in the pathophysiologic condition of immune hydrops fetalis.
      STUDY DESIGN: Umbilical venous pressure (corrected for ambient amniotic fluid pressure) and colloid osmotic pressure were measured during intravascular transfusion. Fetal hydrops was defined as the presence of ascites by ultrasonography. The Mann-Whitney test was used for comparison of groups; a value of p < 0.05 was considered statistically significant.
      RESULTS: Fifteen hydropic fetuses were matched for gestational age with 15 nonhydropic fetuses also undergoing intrauterine transfusion for anemia. On comparison with their nonhydropic counterparts, hydropic fetuses had a statistically lower colloid osmotic pressure. Umbilical venous pressure was higher and the colloid osmotic pressure – umbilical venous pressure gradient was lower in association with fetal hydrops although these differences did not achieve statistical significance.
      CONCLUSION: Mild abnormalities of intravascular Starling forces may play a role in the formation of hydrops in anemic fetuses. (Am J Obstet Gynecol 1992;167:907–12.)

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Starling EH
        On absorption of fluids from the connective tissue spaces.
        J Physiol. 1896; 19: 312-326
        • Chavéz GF
        • Mulinare J
        • Edmonds LD
        Epidemiology of Rh hemolytic disease of the newborn in the United States.
        JAMA. 1991; 265: 3270-3274
        • Nicolaides KH
        • Thilaganathan B
        • Rodeck CH
        • Mibashan RS
        Erythroblastosis and reticulocytosis in anemic fetuses.
        Am J Obstet Gynecol. 1988; 159: 1063-1065
        • Diamond LK
        • Blackfan KD
        • Baty JM
        Erythroblastosis fetalis and its association with universal edema of the fetus, icterus gravis neonatorum and anemia of the newborn.
        J Pediatr. 1932; 1: 269-309
        • Bowman JM
        The management of Rh-isoimmunization.
        Obstet Gynecol. 1978; 52: 1-16
        • Moise KJ
        • Carpenter RJ
        • Kirshon B
        • Deter RL
        • Sala JD
        • Cano LE
        Comparison of four types of intrauterine transfusion: effect on fetal hematocrit.
        Fetal Ther. 1989; 4: 126-137
        • Roberts AB
        • Mitchell JM
        • Pattison NS
        Fetal liver length in normal and isoimmunized pregnancies.
        Am J Obstet Gynecol. 1989; 161: 42-46
        • Mollison PL
        • Cutbush M
        Haemolytic disease of the newborn: criteria of severity.
        BMJ. 1949; 1: 123-130
        • Phibbs RH
        • Johnson P
        • Kitterman JA
        • Gregory GA
        • Tooley WH
        • Schlueter M
        Cardiorespiratory status of erythroblastotic newborn infants. I. Intravascular pressures during the first few hours of life.
        Pediatrics. 1976; 58: 484-493
        • Leduc L
        • Moise KJ
        • Carpenter RJ
        • Cano LE
        Fetoplacental blood volume estimation in pregnancies with Rh alloimmunization.
        Fetal Diagn Ther. 1990; 5: 138-146
        • Phibbs RH
        • Johnson P
        • Tooley WH
        Cardiorespiratory status of erythroblastotic newborn infants. II. Blood volume, hematocrit, and serum albumin concentration in relation to hydrops fetalis.
        Pediatrics. 1974; 53: 13-23
        • Heymann MA
        Fetal cardiovascular physiology.
        in: Creasy RK Resnik R Maternal-fetal medicine: principles and practice. 2nd ed. WB Saunders, Philadelphia1989: 288-302
        • Weiner CP
        • Pelzer GD
        • Heilskov J
        • Wenstrom KD
        • Williamson RA
        The effect of intravascular transfusion on umbilical venous pressure in anemic fetuses with and without hydrops.
        Am J Obstet Gynecol. 1989; 161: 1498-1501
        • Baum JD
        • Harris D
        Colloid osmotic pressure in erythroblastosis fetalis.
        BMJ. 1972; 1: 601-603
        • Wu PY
        • Rockwell G
        • Cahn L
        • et al.
        Colloid osmotic pressure in newborn infants: variations with birth weight, gestational age, total serum solids, and mean arterial pressure.
        Pediatrics. 1981; 68: 814-819
        • Hallman N
        • Norio R
        • Rapola J
        Congenital nephrotic syndrome.
        Nephron. 1973; 11: 101-110
        • Cormode EJ
        • Lyster DM
        • Israels S
        Analbuminemia in a neonate.
        J Pediatr. 1975; 86: 862-867
        • Moïse AA
        • Gest AL
        • Weickmann PH
        • McMicken HW
        Reduction in plasma protein does not affect body water content in fetal sheep.
        Pediatr Res. 1991; 29: 623-626
        • McFadyen IR
        • Boonyaprakob U
        • Hutchinson DL
        Experimental production of anemia in fetal lambs.
        Am J Obstet Gynecol. 1968; 100: 686-695
        • Brace RA
        Thoracic duct lymph flow and its measurement in chronically catheterized sheep fetus.
        Am J Physiol. 1989; 256: H16-H20
        • Brace RA
        Effects of outflow pressure on fetal lymph flow.
        Am J Obstet Gynecol. 1989; 160: 494-497
        • Nimrod C
        • Davies D
        • Harder J
        • et al.
        Ultrasound evaluation of tachycardia-induced hydrops in the fetal lamb.
        Am J Obstet Gynecol. 1987; 157: 655-659
        • Lewis M
        • Bowman JM
        • Pollack J
        • Lowen B
        Absorption of red cells from the peritoneal cavity of an hydropic twin.
        Transfusion. 1973; 13: 37-40