Intrauterine management of fetal parvovirus B19 infection

• Published in: Ultrasound in obstetrics & gynecology 1999-03, Vol.13 (3), p.161-166
• Main Authors: Schild, R. L., Bald, R., Plath, H., Eis‐Hübinger, A. M., Enders, G., Hansmann, M.
• Format: Article
• Language: English
• Subjects: Anemia - therapy; Anemia - virology; Blood Transfusion, Intrauterine; Cordocentesis; Erythrocyte Transfusion; Female; fetal anemia; Fetal Blood - chemistry; Fetal Blood - cytology; Fetal Death - etiology; Fetal Diseases - therapy; Fetal Diseases - virology; fetal hydrops; fetal outcome; Follow-Up Studies; Gestational Age; Hemoglobins - analysis; Humans; Hydrops Fetalis - therapy; Hydrops Fetalis - virology; intrauterine infection; intrauterine transfusion; Parvoviridae Infections - therapy; parvovirus B19; Parvovirus B19, Human; Platelet Count; Pregnancy; Pregnancy Complications, Infectious - virology; Pregnancy Outcome; Retrospective Studies; Umbilical Veins
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1046/j.1469-0705.1999.13030161.x

Objectives The aim of our study was to determine the outcome of pregnancies after intrauterine management of fetal parvovirus B19 infection. Design Retrospective study. Subjects A total of 37 cases of maternofetal parvovirus B19 infection, 35 of which were associated with hydrops fetalis, were referred to our tertiary level center between 1989 and 1996. With regard to fetal hydrops, no apparent cause other than parvovirus B19 infection was found in any patient. Methods In all patients, cordocentesis was performed to assess the degree of fetal anemia. When anemia was pre‐sent, cordocentesis was followed by intrauterine transfusion with packed red cells into the umbilical vein. Further management depended on the degree of fetal anemia and gestational age and included follow‐up fetal blood sampling/transfusion as well as ultrasound examinations as deemed appropriate. Results Packed red cell transfusion was performed in 30 patients with significant fetal anemia (Z‐score 1.6–7.8 below the mean for gestational age). The fetal hemoglobin values ranged from 2.1 to 9.6 g/dl. Serum levels of platelets in the transfusion group were 9–228 × 109/l with Z‐scores in the range of < 1 to 3.8 below the mean. During treatment and follow‐up, there were five intrauterine deaths (13.5%), one neonatal death (2.7%) and 31 live births (83.8%). Conclusions Fetal parvovirus infection can lead to marked anemia and hydrops formation. Cordocentesis allows precise assessment of fetal anemia which can then be corrected by intravenous transfusion. Under this regimen, the outcome proved favorable in the majority of fetuses, even those that were severely anemic. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology