Report of a case of non-immune hydropsfetalis. Importance of Parvovirus B19 infection screening in pregnant women for a timely diagnosis
Abstract: Hydropsfetalis (HF) occurs in 1/600 pregnancies. With the introduction of Rhesus-immunoprophylaxis, only 50% are caused by Rh-hemolytic disease. Non-immunological causes are heart defects, chromosomal abnormalities, twin-twin transfusion syndrome, or infections by Parvovirus B19/...
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| Autores principales: | , , , , , , , , , , , |
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| Formato: | Artículo revista |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2021
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/34879 |
| Aporte de: |
| Sumario: | Abstract:
Hydropsfetalis (HF) occurs in 1/600 pregnancies. With the introduction of Rhesus-immunoprophylaxis, only 50% are caused by Rh-hemolytic disease. Non-immunological causes are heart defects, chromosomal abnormalities, twin-twin transfusion syndrome, or infections by Parvovirus B19/B19V, among others. B19V can infect susceptible pregnant women causing a wide variety of conditions, including hydrops (with anemia, heart failure and/or fetal-neonatal death).
Objective: to report a case of non-immune HF with B19V as the possible etiology, in order to highlight the importance of its investigation in the pregnant woman.
Clinical case. Para2 gravida3 patient, 32 yr.old, 33.5 weeks gestation/wg, derived from a town in the Province of Córdoba with a probable diagnosis of Rh isoimmunization. She was admitted to the Hospital Universitario de Marternidad y Neonatología/HUMN presenting anemia, threat of preterm labor, and a hydropic fetus on ultrasound. Uterus-inhibition and fetal lung maturation were initiated. The patient did not report fever or other parvoviral symptoms. Laboratory: hemoglobin 7.6 g/dl, hematocrit 22%. Ultrasound control showed fetal right hydrothorax, polyhydramnios and fetal bradycardia, thus a cesarean section was decided and a baby male was born. The patient evolved favorably during the puerperium. Placenta biopsy: chorio-amnionitis. Newborn was premature/34 wg, large for gestational age/3200gr. Apgar score 1/1/3. He presented generalized edema, hydrothorax and ascites. He was admitted to Neonatal Intensive Care Unit in a serious general condition: hemodynamic- hepatic- and renal- compromise, multi-factorial jaundice. Drains and transfusions were performed and mechanical ventilation was required. Supplementaloxygenwaswithdrawn at 40 days. Discharge at 50 days.
Studies: Mother 0(Rh-), newborn 0(Rh+); Coombs test: negative. Only anti-B19V IgG was found in the mother (11.6 IU/ml). Other infections such as syphilis, toxoplasmosis, Chagas (T.cruzi), cytomegalovirus, Hepatitis B/C, and HIV were discarded by serology. Newborn: B19V IgM and DNA were negative.
Conclusions: a case of non-immune hydropsfetalis with a probable diagnosis of B19V infection is reported. The interpretation of laboratory results (serology/DNA) for the diagnosis of vertical infection is complex, depending on which/when clinical samples are obtained. It is important to consider screening of B19V infection in pregnant women in order to optimize the diagnosis of non-immune hydropsfetalis. |
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