Objectives: To determine rates of fetal anaemia and pregnancy outcome in susceptible pregnant women infected with human parvovirus B19 infection in a tertiary fetal medicine department over a 7-year period. Additional features enabling identification of fetuses that progress to severe anaemia were also investigated. Methods: Forty-seven susceptible, pregnant women with confirmed parvovirus infection referred to a regional fetal medicine unit, over a 7-year period (1999–2006), were identified. Where possible maternal serum AFP measurements were obtained from second-trimester serum screening and the presence or absence of echogenic bowel noted. Results: Of the 47 cases, one was excluded. Of the remaining 46 cases, 34 (74%) showed no signs of fetal anaemia and delivered at term. The remaining 12 (26%) showed signs of fetal anaemia. Eight of the 12 developed hydrops and underwent fetal blood sampling and transfusion (median pretransfusion Hb 3.6 g/dl). Seven of the 8 transfused fetuses were thrombocytopenic with a platelet count <150 × 10⁹/l, with 2 fetuses having platelet counts <50 × 10⁹/l. The median gestation age at transfusion was 22 weeks (range 18–27 weeks). The median number of weeks between seroconversion and transfusion was 6 (range 3–12). The signs of anaemia resolved after one transfusion in 5 of the 8 transfused fetuses and they subsequently delivered at term. There were 2 fetal deaths during or shortly after transfusion and one neonatal death following delivery at 28 weeks gestation due to severe pre-eclampsia, 5 days after successful transfusion. Conclusions: Following parvovirus seroconversion, the incidence of significant fetal anaemia requiring transfusion was 17%. Seroconversion after 21 weeks did not result in severe fetal anaemia. Significant anaemia requiring intervention did not occur 12 weeks after maternal seroconversion. We did not demonstrate a correlation with either maternal serum AFP or the presence of fetal echogenic bowel and the development of severe fetal anaemia. Because of the association between fetal anaemia and severe thrombocytopenia, it may be prudent to have compatible platelets available at the time of fetal blood sampling.

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Introduction This study was conducted within the tertiary Fetal Medicine Unit (FMU) at St Michael's Hospital (StMH), Bristol. The first aim was to provide improved information regarding neonatal outcomes for parents of pregnancies affected by Haemolytic Disease of the Fetus and Newborn (HDFN) and managed by intrauterine transfusion (IUT). The second aim was to determine if a change in IUT protocol in 2004 had improved safety; including attendance of two FMU Consultants, use of fetal sedation, and use of the intrahepatic vein as an alternative route to placental cord insertion if deemed safer. Methods Data for pregnancies affected by HDFN as a result of haemolytic red cell alloimmunisation and managed with IUT at StMH between 1999 and 2009 were retrospectively collected using local databases, and review of the medical notes. Results 256 relevant IUTs were performed. The median number of IUTs per pregnancy was two. 91% of live deliveries had five minute APGAR scores ≥9. 98% were admitted to NICU/SCBU; requiring phototherapy (96%), exchange transfusion (36%) and top-up transfusion (30% immediate, 13% late). Following the change in protocol, there was a significant reduction in the number of emergency caesarean sections occurring directly after an IUT procedure (n=5vs0;p=0.02). 1% of IUTs resulted in fetal loss within 48 hours of IUT, none of which occurred under the new protocol (n=3vs0;p=0.08NS). Conclusions Although the majority of neonates required admission to NICU/SCBU and phototherapy, the median-term outcomes were positive. Importantly, the safety of the IUT procedure has significantly improved since the change in protocol.

Introduction Eclampsia is a common cause of new onset self-terminating tonic-clonic seizures in term pregnancy. Other causes of seizures such as epilepsy and central nervous system infection, haemorrhage, infarction, mass or thrombosis are considered as differential diagnoses when there is atypical presentation. Case report: A 25 year old Somalian woman presented to delivery suite at 38 weeks of pregnancy with a 12 hour history of headache, confusion and one episode of self-terminating tonic-clonic seizure. She was in her third uncomplicated pregnancy with the past medical history of tubercular sacroiliitis. She completed anti-tubercular treatment and was discharged from the TB clinic prior to this pregnancy. On arrival to the delivery suite the patient was confused, agitated and combative. Her blood pressure was normal. It was difficult to accurately assess her neurological state due to her degree of agitation. However bilateral upgoing plantars were noted with no other apparent neurological abnormality. A presumed diagnosis of eclampsia was made. Magnesium sulphate infusion was commenced with no improvement in clinical condition. The patient was intubated for further investigation and management. A lower segment caesarean section was performed and she was transferred to the intensive care unit for ventilatory support. Following extensive investigation she was diagnosed with TB meningitis and bilateral parietal tuberculomas. Conclusion The purpose of this report is to illustrate a relatively rare cause of seizures in pregnancy. With TB affecting an increasing number of patients in UK hospitals, it is an important differential diagnosis for a vast range of presenting complaints.