In utero treatment of severe fetal anaemia due to parvovirus B19 in one fetus in a twin pregnancy--a case report and literature review.
BACKGROUND
Parvovirus B19 (PVB19) is a well-established cause of nonimmune hydrops fetalis and fetal anaemia in pregnancy. However, discordant viral infection of only 1 fetus in a twin pregnancy is a rare occurrence.


METHODS
A 40-year-old female with dichorionic, diamniotic twin pregnancy presented at 22 weeks with fetal hydrops and severe anaemia in 1 twin. Maternal PVB19 infection was confirmed, and the affected fetus was treated with a single intrauterine transfusion. The only subsequent complication developed was that the affected fetus was growing on the 5th centile. The affected twin continued to grow, and 2 live twins were delivered by caesarean section at 36 weeks. By 18 months of age, the affected twin had normal development.


CONCLUSIONS
PVB19 may selectively affect 1 fetus in a dichorionic, diamniotic twin pregnancy and may be treated efficiently with intrauterine transfusion. Discordant viral infection in this case suggests that the viral load may be limited to 1 placenta and/or that different individual immunological fetal response starts very early in utero.
Bekhit
M T
MT
Department of Obstetrics and Gynaecology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK. mtbekhit@yahoo.co.uk
Greenwood
P A
PA
Warren
R
R
Aarons
E
E
Jauniaux
E
E
D000328:Adult; D000740:Anemia / Q000821:virology*; D001805:Blood Transfusion, Intrauterine; D005260:Female; D005312:Fetal Blood / Q000821:virology; D005333:Fetus / Q000821:virology*; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging / Q000821:virology*; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D048208:Nuchal Translucency Measurement; D010322:Parvoviridae Infections / Q000150:complications / Q000628:therapy* / Q000635:transmission; D016732:Parvovirus B19, Human / Q000302:isolation & purification; D011247:Pregnancy; D011272:Pregnancy, Multiple