Fetal morbidity and mortality after acute human parvovirus B19 infection in pregnancy: prospective evaluation of 1018 cases (original) (raw)
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Long-term outcome in fetal hydrops from parvovirus B19 infection
American Journal of Obstetrics and Gynecology, 1992
Parvovirus B19 infection in the fetus is associated with anemia and hydrops and can result in fetal death. Fetal transfusion has been used in an attempt to improve outcome ; however, it is associated with its own perinatal morbidity. We report two cases of fetal parvovirus B19 infection that were confirmed by polymerase chain reaction for parvovirus B19 deoxyribonucleic acid in umbilical cord blood. Ultrasonographic signs of compromise were observed at 30 and 24 weeks of gestation. Both fetuses were hydropic and one fetus was also anemic. Serial sonograms demonstrated that the hydrops resolved spontaneously over 3 to 5 weeks after diagnosis. One infant was delivered at 32 weeks of gestation as a result of idiopathic preterm labor. The other infant was delivered at term. Both infants appeared relatively normal at birth and have developed normally in the first year of life. Thus fetal hydrops in association with parvovirus 819 infection does not always lead to poor long-term outcome . A conservative approach without in utero therapy may be appropriate for the management of some of these fetuses . (AMJ OasTET GVNECOL 1992;167:337-41.)
Revista română de boli infecţioase, 2016
Parvovirus B19 belongs to the Parvoviridae family, Erythrovirus type, and it presents cytotoxicity on the erythroblast human line leading to severe anemia. We present the case of a 35-year-old woman, at the 3rd pregnancy, with a first trimester abortion in her history and a physiological birth, who presented to the specialty checkup at 20 gestational weeks, associating the signs of a respiratory infection, without any other pathologies until this gestational age. The laboratory tests and the fetal ultrasound did not point out any pathological elements, therefore the patient was sent home with the recommendation to come back after 2 weeks for reevaluation, when the fetal ultrasound revealed fetal hydrops and severe anemia, and after 24 hours fetal asystole. Maternal serology pointed out recent infection with Parvovirus B19. The particularity of this case consists in the appearance of relative rare fetal infection in the second trimester of pregnancy in the case of a physiological, monitored pregnancy, with unfavorable prognosis and fulminant death towards intrauterine death.
Revised Clinical Presentation of Parvovirus B19–Associated Intrauterine Fetal Death
Clinical Infectious Diseases, 2002
Adverse pregnancy outcome due to human parvovirus B19 (hereafter referred to as "parvovirus B19") has been characterized, in numerous reports, as an event that occurs during the first and second trimesters and is strongly associated with symptoms of fetal hydrops. Recent findings have indicated that parvovirus B19-associated intrauterine fetal death (IUFD) is also a problem in late gestation, although its clinical presentation is aberrant, lacking signs of fetal hydrops. We outlined the clinical presentation and assessed the frequency of parvovirus B19 infection in a retrospective analysis of 92 unselected cases of IUFD that occurred during or after gestational week 22. By polymerase chain reaction, parvovirus B19 DNA was detected in 13 (14%) of the 92 cases. Only 2 of the parvovirus B19 DNA-positive cases were hydropic, both representing early IUFDs. This finding indicates that parvovirus B19-associated IUFD in late gestation is a common finding and that hydropic presentation is rare. This knowledge may contribute to a reduction in the number of unexplained cases of IUFD. Neonatal mortality rates have significantly decreased during recent years because of improved perinatal care, but no comparable reduction in antenatal mortality rates has been observed [1, 2]. This could be explained, in part, by the fact that the etiology of a large proportion of intrauterine fetal deaths (IUFDs) is unknown, and different studies have shown that no identifiable cause can be determined for 12%-50% of stillbirths [3, 4]. Human parvovirus B19 (hereafter known as "parvovirus B19") was first reported to be associated with fetal death in 1984 [5, 6], and later investigations have
Hydrops fetalis caused by parvovirus B19 infection: case report and literature review
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006
An intrauterine parvovirus B19 infection can result in severe fetal anemia and hydrops fetalis, which can lead to death. A case of fetal hydrops, diagnosed at 31 weeks gestation, is reported Cordocentesis revealed fetal hemoglobin of 5 g/dL. Due to fetal distress 18 hours later, the baby was delivered by emergency cesarean section and died two days later. Characteristic intra-nuclear inclusions in nucleated red blood cells were found in histopathological examinations of the liver and placenta, which supported the diagnosis of parvovirus B19 infection. Literatures about parvovirus B19 infection, especially intrauterine infection, its effects on the fetus, methods of diagnosis and management, were reviewed.
Frequency of human parvovirus B19 infection in intrauterine fetal death
The Lancet, 2001
Background Parvovirus B19 is known to cause fetal death in the second trimester, mainly in combination with hydrops fetalis. However, the frequency of parvovirus-B19-associated non-hydropic fetal loss in the late second and third trimester has not been thoroughly investigated. We aimed to investigate the frequency of parvovirus B19 infection in unselected cases of intrauterine fetal death and to assess the sensitivity of different diagnostic procedures. Methods Of 14 147 deliveries in three hospitals in the major Stockholm area of Sweden, all cases of intrauterine fetal death (у22 gestational weeks) that occurred between January, 1998, and May, 1999 (n=47), referred cases of miscarriage (<22 gestational weeks, n=37), and induced abortions (n=29), were included in the study. Placental and fetal tissues were examined by means of parvovirus-B19specific PCR, histopathology, and immunohistochemistry. Placental tissues from 53 normal pregnancies at term were also examined. Findings Significantly more cases of intrauterine fetal death were positive for parvovirus B19 DNA (seven [15%]) than were normal pregnancies at term (zero, p=0•049). Furthermore, parvovirus B19 DNA was found in two (5%) of the miscarriages but not in any of the cases of induced abortion. Only three of nine DNA-positive cases had parvovirus-B19-associated inclusions and stained positive for viral proteins. All but one of the DNA-positive cases of intrauterine fetal death were non-hydropic. Interpretation The presence of parvovirus B19 DNA in cases of late second-trimester and third-trimester fetal death is common, and most are non-hydropic. The sensitivity of conventional diagnostic procedures for intrauterine fetal death could be greatly improved by addition of parvovirus B19 PCR.
Parvovirus B19 Infection in Fetal Deaths
Clinical Infectious Diseases, 2008
Background. Parvovirus B19 infection during pregnancy can lead to nonimmune fetal hydrops, miscarriage, and intrauterine fetal death (IUFD). Some studies have suggested that parvovirus B19 infection may surprisingly often result in nonhydropic fetal death during the third trimester, in the absence of maternal serological evidence of acute infection. This study was conducted to investigate the prevalence of parvovirus B19 DNA among fetuses from miscarriages and IUFDs. Methods. We retrospectively studied 535 unborn fetuses, including 120 fetuses from miscarriages and 169 from IUFDs. The control fetuses were 246 fetuses from induced abortions.
Haematological parameters of parvovirus B19 infection in 13 fetuses with hydrops foetalis
British Journal of Haematology, 1999
Thirteen cases of fetal parvovirus B19 infection with hydrops foetalis are reported. Viral DNA was identified by polymerase chain reaction (PCR) of amniotic fluid sampled between the 19th and the 29th week of gestation. Haematological examination revealed severe anaemia in all cases and thrombocytopenia in 11/13 cases, which was severe in two cases. Six fetuses died in utero; two after intrauterine transfusion. Complete recovery was observed in seven fetuses; five cases were treated by intrauterine transfusions, and in two cases spontaneous recovery occurred. Upon follow-up, no case of congenital anaemia was observed.
Fetal pathology in human parvovirus B19 infection
BJOG: An International Journal of Obstetrics and Gynaecology, 1989
In a current Netherlands study on the effects on mother and child of infection with the human parvovirus B19 during pregnancy, 10 pregnancies have been reported. Three of them ended before term: two in fetal death and one by elective abortion. In two of these fetuses B19 infection in cells other than those of the erythroid series was demonstrated, and in the one terminated, ocular malformation and extensive inflammatory reactions in all fetal and placental tissues were found. The presence of B19 DNA was demonstrated by dot hybridization in placental and fetal tissues. In the third no gross fetal abnormalities were found, although B19 DNA was detected in several fetal tissues by in-situ hybridization. Of the remaining seven pregnancies, six ended at term in the birth of apparently healthy babies. The other child was born near term with a low birthweight and multiple congenital malformations, but with no proof of intrauterine B1Y infection. It is concluded that Bl9 infection in pregnancy can interfere with organ devclopment and may lead to intrauterine fetal death.