Hydrops

TTTS. Stage IV: Hydrops

Stage IV is defined by the presence of ascites, pericardial or pleural effusion, and scalp or skin edema (Figure 7.12a–c). Most if not all of these ultrasound findings are subjective. However, for the purposes of follow-up, the degree of third spacing may be monitored. 

Thus, the scalp may be measured at the level of the biparietal diameter as the distance from the skin to the parietal bone; pleural effusion may be measured as the transverse distance from the tip of the lung to the inner chest wall at the level of the base of the lung;

pericardial effusion may be measured at the level of the four-chamber view as the distance between the right atrium and the pericardium in diastole; ascites may be measured at the abdominal circumference level as the distance between the anterior edge of the liver and the inner abdominal wall. Skin edema may also be measured at the level of the abdominal circumference.