Fetal Hydrops and Severe Anemia Caused by Parvovirus Infection

Introduction Parvovirus B19 (PB19) is the only virus from the Parvoviridae family that can be infectious to humans [1]. Most adults have immunity due to a prior infection during childhood [1–3]. Women not immune to PB19 and infected during gestation period may suffer from chronic anemia, aplastic crisis, hydrops fetalis and fetal loss in rare instances [2,4]. One or two intrauterine blood transfusions (IUTs) can decrease mortality and morbidity in PB19-affected fetuses with severe anemia and hydrops [4,5]. Case Presentation A 29-year-old patient was admitted to the hospital at 26 weeks of gestation (second pregnancy) after fetal anemia, ascites, and hydropericardium were detected during routine ultrasound examination. There were no uterine contractions, amniotic fluid did not flow. The first child had PB19 when patient was 12 weeks pregnant. Lab results revealed IgG and IgM antibodies against PB19. It was determined to perform cordocentesis and intrauterine blood transfusion due to fetal anemia. After the procedure, pathological signs subsided. During further monitoring, sings of anemia started reappearing 23 days after IUT. At 37 weeks of pregnancy patient felt weaker fetal movements, as well as irregular uterine contractions, for a few days. Lab results showed fetal erythrocytes in mother’s blood. Labor was induced using dilators due to severe fetal anemia. A healthy female newborn with Apgar score 10-10 was delivered naturally in the occipital position. The early and further postpartum period was without complications. Discussion Parvovirus B19 infection acquired during the gestation period has a 30 % risk of perinatal transmission [3,6]. The infected pregnant patient may be asymptomatic or experience rashes and joint pain. Vertical transmission can cause severe anemia, which can be detected by examining the middle cerebral artery using a Doppler, and for which the only viable treatment is intrauterine blood transfusion [2,5,7]. Detection of IgM and IgG antibodies is one of the best methods to diagnose PB19 in pregnant women, but there is no vaccine or antiviral treatment [8]. Conclusions Early diagnosis and management of parvovirus B19 during gestation are crucial to avert severe complications such as fetal anemia. This case exemplifies how a timely intrauterine transfusion can ensure a good outcome for both the mother and the child.