Intrauterine management of fetal parvovirus B19 infection

• DOI: 10.1046/j.1469-0705.1999.13030161.x
• Publication Date: 2003-03-12T23:09:51Z
• Authors: R. L. Schild; R. Bald; H. Plath; A. M. Eis‐Hübinger; G. Enders; M. Hansmann
• Keywords: Platelet Count; Hydrops Fetalis; Pregnancy Outcome; Blood Transfusion, Intrauterine; Anemia; Gestational Age; Fetal Blood; 3. Good health; Parvoviridae Infections; Fetal Diseases; Hemoglobins; 03 medical and health sciences; 0302 clinical medicine; Pregnancy; Parvovirus B19, Human; Humans; Female; Pregnancy Complications, Infectious; Cordocentesis; Erythrocyte Transfusion; Fetal Death; Follow-Up Studies; Retrospective Studies

AbstractObjectivesThe aim of our study was to determine the outcome of pregnancies after intrauterine management of fetal parvovirus B19 infection.DesignRetrospective study.SubjectsA 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.MethodsIn 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.ResultsPacked 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%).ConclusionsFetal 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