Clinical presentation and outcome of 20 fetuses with parvovirus B19 infection complicated by severe anemia and/or fetal hydrops.
OBJECTIVE
The aim of this study was to assess the prognosis of parvovirus B19 infection with severely anemic and/or hydropic fetuses according to initial ultrasound and biological criteria.


METHODS
Retrospective study of 20 cases of congenital parvovirus B19-proven infection (positive PCR) complicated by fetal anemia and/or hydrops was examined. Anemia was suspected on an elevated peak systolic velocity of the middle cerebral artery and was confirmed by fetal blood sampling.


RESULTS
Survival rate was 70% (14/20) overall and 76% (13/17) for fetuses with one or more transfusions. When fetal effusion regressed after the transfusion, all 11 fetuses survived, and neonatal condition was favorable for all. Among the 14 live-born children, there was one neonatal death and one admission to the neonatal care unit with no major complications.


CONCLUSIONS
Despite active management by transfusion in fetuses with parvovirus B19 infection, mortality remained substantial during the acute phase of anemia and fetal hydrops. Regression of effusion appears to be an important variable for prognosis. Non-anemic forms exist with isolated refractory ascites or pleural effusion. Maternal mirror syndrome appears to reflect the intensity and persistence of the fetal anemia.
Unité d'Obstétrique-Maternité, Hôpital Trousseau, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, France; Service de Gynécologie-Obstétrique, CHU Bocage, Université de Bourgogne, Dijon, France.
Guillaume
G
Macé
Marine
M
Sauvan
Vanina
V
Castaigne
Marie-Laure
ML
Moutard
Anne
A
Cortey
Emeline
E
Maisonneuve
Catherine
C
Garel
Ferdinand
F
Dhombres
Jeremy
J
Boujenah
Agnès
A
Mailloux
Bruno
B
Carbonne
D000740:Anemia / Q000150:complications / Q000151:congenital / Q000000981:diagnostic imaging* / Q000628:therapy; D001805:Blood Transfusion, Intrauterine; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging* / Q000628:therapy; D010322:Parvoviridae Infections / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D016732:Parvovirus B19, Human / Q000302:isolation & purification; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000000981:diagnostic imaging / Q000628:therapy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography