Hydrops Fetalis and Severe Fetal Anemia Due to Parvovirus B19 Infection. A Case Report

Abstract

Introduction Parvovirus B19 infection during pregnancy, particularly in the first and second trimesters, can lead to severe fetal complications, including anemia, heart failure, hydrops and long-term sequelae. In severe cases, it can result in fetal mortality. [1-4] Case Presentation A 29-year-old woman presented for a routine check-up without any complaints, reporting good fetal movements. She was hospitalized after ultrasound (US) findings suggested hydrops fetalis. US revealed pericardial effusion (7 mm), ascites (17 mm), tricuspid regurgitation, shortened long bones (femur <1st percentile, humerus <3rd percentile), and an MCA Vmax of 56 cm/s (1.6 MoM), indicating severe fetal anemia. The patient’s first child had a confirmed Parvovirus B19 infection during her 12th week of gestation. The patient was asymptomatic. This second pregnancy was complicated by gestational diabetes mellitus (White A1). The diagnostic plan included US monitoring, nonstress tests, TORCH screen, and Parvovirus testing. Serological tests confirmed Parvovirus B19 infection (IgG 150, IgM 15.9). A multidisciplinary team recommended intrauterine blood transfusion (IUT) via cordocentesis, resulting in significant improvement in fetal status: anemia and tricuspid regurgitation resolved, pericardial effusion and ascites decreased. After discharge, the patient was referred for genetic counseling and diagnostic amniocentesis. At 37+3 weeks, the patient was readmitted with reduced fetal movements and suspected fetal anemia. Labor was induced, and a female neonate was delivered vaginally (2570 g, Apgar 10/10). No evidence of neonatal anemia or other morbidities was found following the delivery of the fetus. Discussion Invasive treatment modalities are not recommended for fetal Parvovirus B19 cases with mild anemia, as hydrops may spontaneously regress. In such cases, close ultrasound monitoring and serial MCV-PSV measurements are sufficient. [3] However, IUTs are essential for managing severe fetal anemia, improving perinatal outcomes, and resolving Parvovirus B19 infection in 55.1% of hydropic fetuses. [1–5] Conclusions This case demonstrates the benefits of early detection and timely intrauterine therapy in pregnancies severely complicated by Parvovirus B19.