title: Ultrasound diagnosis, management and prognosis in a consecutive series of 27 cases of fetal hydrops following maternal parvovirus B19 infection.
abstract: BACKGROUND
  Fetal hydrops caused by anemia from parvovirus B19 infection (FH-B19) is rare. Doppler measurement of the middle cerebral artery peak systolic velocity (PSV-MCA) improves its prenatal diagnosis, but its frequency and prognosis are still poorly known. Despite improved survival due to in utero transfusions, the possibility of late neurological sequelae makes prognosis uncertain.
  
  
  OBJECTIVE
  To assess the frequency, management and prognosis of a consecutive series of FH-B19 observed over a 15-year period.
  
  
  METHODS
  Retrospective study of 27 cases of FH-B19, that is, 3/100,000 births, 24 of them discovered during routine second-trimester ultrasound. All but 1 case (96.2%) had at least four of the six ultrasound signs that Saltzman et al. [Obstet Gynecol 1989;74:106-111] suggested as indicators of anemia. Of the fetuses tested, 80% had a PSV-MCA >1.5 MoM, also indicative of anemia. Of the 19 fetuses treated by exchange transfusions, 11 were liveborn compared with 2 of the 6 not so treated (57.8 vs. 33.3%, NS). The survival rate was higher during the second half of the study period (23.1 vs. 71.4%, p < 0.02) for less severe anemia (p < 0.03) and for repeated transfusions (p = 0.03). In our series, 1 case of prenatal cerebral atrophy was identified on screening. All 13 liveborn children appeared healthy at the age of 1 year.
  
  
  CONCLUSIONS
  In cases of fetal hydrops, Saltzman et al.'s ultrasound criteria and PSV-MCA measurement made it possible to determine the likelihood that anemia is the cause of the hydrops and to measure its intensity. Use of these techniques allowed us to choose the most appropriate treatment (transfusion or not, depending on the degree of anemia), and survival improved notably in our series.
authors.affiliation: Pôle d'Obstétrique, Hôpital Jeanne de Flandre, Université Lille II, Lille, France. chauvetagathe@hotmail.com
authors.forename: Agathe
authors.initials: A
authors.lastname: Chauvet
authors.forename: Anny
authors.initials: A
authors.lastname: Dewilde
authors.forename: Dominique
authors.initials: D
authors.lastname: Thomas
authors.forename: Sylvie
authors.initials: S
authors.lastname: Joriot
authors.forename: Pascal
authors.initials: P
authors.lastname: Vaast
authors.forename: Véronique
authors.initials: V
authors.lastname: Houfflin-Debarge
authors.forename: Damien
authors.initials: D
authors.lastname: Subtil
mesh_terms: D016731:Erythema Infectiosum / Q000150:complications* / Q000000981:diagnostic imaging / Q000821:virology; D005260:Female; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging / Q000821:virology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000000981:diagnostic imaging*; D011379:Prognosis; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal