Severe Anemia, Hydrops and Fetal Death Caused by Parvovirus B19 Infection

Abstract

Introduction Parvovirus B19 is a single-stranded DNA virus that infects erythroid progenitor cells in bone marrow and liver and causes erythema infectiosum, acute aplastic crisis, cytopenia and more [1,2]. Parvovirus B19 infection in pregnancy can be transmitted to the fetus through the placenta and may cause fetal anemia, nonimmune hydrops fetalis and even pregnancy loss [3]. Case Presentation A 35-year-old patient was admitted to the hospital due to fetal anemia and hydrops (hydropericardium, hydrothorax, ascites) diagnosed during routine ultrasound examination at 24 weeks of pregnancy. She felt weaker fetus’ movement for two weeks. There were no uterine contractions and amniotic fluid did not flow. Her obstetric history included one miscarriage at 9 weeks and one normal pregnancy with a healthy child. The patient admits that her 7- year-old child had parvovirus B19 infection three months prior. IgG and IgM for Parvovirus B19 came back positive. Cordocentesis and erythrocyte mass transfusion for the fetus was planned but the next day ultrasound showed intrauterine fetal demise. Labor was induced with misoprostol and after 4 hours and 10 minutes the patient gave stillbirth to a female fetus of 866 g. The autopsy of the fetus confirmed fetal anemia and hydrops caused by parvovirus B19 intrauterine infection as the cause of death. Discussion The overall risk of adverse fetal outcomes in parvovirus B19 infection ranges from 3% to 12% [2]. Screening for parvovirus B19 is not included in antenatal tests for all pregnant women. The infection is asymptomatic in most cases or associated with rash or polyarthralgia [4]. Laboratory diagnosis is based on IgG and IgM antibody detection [5]. Intrauterine blood transfusion is considered the most successful treatment for fetal anemia caused by parvovirus B19 and it can be performed multiple times until anemia is corrected [6]. So far, there is no specific antiviral therapy or vaccine for parvovirus B19 [7]. Conclusions Parvovirus B19 infection in pregnancy though rarely causing severe complications, can lead to fetal anemia and hydrops which can cause fetal death in utero. Early diagnosis is necessary, as there are studies that prove effectiveness of intrauterine therapy, highlighting the importance of antenatal screening.