Hydrops Fetalis in a Documented Parvovirus Infection Causing Fetal Mortality

Abstract

Hydrops fetalis is the most deadly complication of parvovirus in pregnancy. This case shows the devastating consequences of the parvovirus infection in a second-trimester fetus and is a valuable reminder that the human parvo B19 virus is an ever-present danger to the fetus.

Fetal Parvovirus B19 Infection Presenting With Nonimmune Hydrops Fetalis

“…[4][5][6] This virus spreads so easily because it is very common in young or school-aged children and is passed through close personal contact, respiratory secretions, and blood. 4,5,7 Once a person has been exposed to this virus, he or she develops immunity, and as a result of parvovirus B19 being so common in young children, only 20% of infections occur in adults. 7 At the onset of pregnancy, 50% to 65% of pregnant women are immune.…”

“…4,5,7 Once a person has been exposed to this virus, he or she develops immunity, and as a result of parvovirus B19 being so common in young children, only 20% of infections occur in adults. 7 At the onset of pregnancy, 50% to 65% of pregnant women are immune. 4 The most common way that pregnant women contract this virus is through close contact with their own children.…”

“…3,4,7,8 There is also an elevated risk for pregnant women in professions such as schoolteachers and daycare providers who have prolonged exposure to young children. 5,7 Children will be asymptomatic 25% of the time and adults 75% of the time when they are infected with parvovirus B19. 4,7 Therefore it is possible for a pregnant woman to be unaware of exposure to the parvovirus.…”

“…4,5 In maternal parvovirus infections, the virus will cross the placenta and infect the fetus 30% to 33% of the time. 4,5,7 A fetus infected with parvovirus B19 will have a 7% chance of developing nonimmune hydrops and a 2% to 10% risk of fetal loss. 3,7 Parvovirus B19 is cytotoxic for erythroid progenitor cells and can lead to fetal anemia by inhibiting erythropoiesis.…”

“…7,10,11 Additional findings associated with fetal hydrops may include polyhydramnios, an edematous placenta, hepatosplenomegaly, and cardiomegaly. 7 Sixty to seventy percent of nonimmune hydrops cases are a result of chromosomal abnormalities, cardiovascular defects, thoracic problems, twin-to-twin transfusion, infection, or anemia. 10 In certain circumstances, sonography may be able to identify the cause of the hydrops, but otherwise, it is used in conjunction with invasive testing in an attempt to identify the source.…”