Prenatal Parvovirus B19 Infection in Fetus

Czech version

Authors: M. Lubušký ¹; D. Pospíšilová ²; J. Hyjánek ³; M. Procházka ¹; I. Míčková ³
Authors‘ workplace: Gynekologicko-porodnická klinika LF UP a FN, Olomouc, přednosta prof. MUDr. M. Kudela, CSc. ¹; Dětská klinika LF UP a FN, Olomouc, přednosta prof. MUDr. V. Mihál, CSc. ²; Ústav lékařské genetiky a fetální medicíny LF UP a FN, Olomouc, přednosta prof. MUDr. J. Šantavý, CSc. ³
Published in: Ceska Gynekol 2005; 70(4): 306-311
Category: Original Article

Overview

Objective:
To analyse 3 cases of parvovirus B19 infection in a pregnant woman followed by transplacental transmission to the fetus.

Design:
A reprospective study.

Setting:
Department of Obstetrics and Gynecology, University Hospital, Olomouc.

Method:
Parvovirus B19 vertical transmission from a pregnant woman to the fetus was diagnosed in 3 cases. Serologic testing of IgG and IgM antibodies against parvovirus B19, cytological bone marrow examination and parvovirus B19 DNA analysis by PCR methods were performed. The fetal anemia was predicted by measurements of peak systolic velocities in the middle cerebral artery (MCA-PSV).

Results:
There were three pregnancies in all (1^st – single, 2^nd and 3^rd – dizygotic twins). In the 1^st and 2^nd pregnancy the diagnosis of parvovirus B19 infection was set on the basis of erythroblastopenia diagnosed in the neonatal period or early infancy. In the 2^ndpregnancy (dizygotic twins) intrauterine death of one twin occured. In the 3^rd case (dizygotic twins) the diagnosis was already set in the 20^th week of pregnancy. Subsequently the fetal anemia was predicted by doppler examination. The fetuses did not require invasive intrauterine intervention and mild anemia was diagnosed after delivery. Progressive intrauterine growth retardation of one twin was observed. Neither cardiomegaly nor fetal hydrops did not occur. All mothers were asymptomatic during the whole pregnancy.

Conclusion:
Parvovirus B19 infection should be excluded in all cases of nonimmune fetal hydrops, severe fetal anemia, cardiomegaly, intrauterine growth retardation (IUGR) and chronic erythroblastopenia diagnosed in the neonatal period or early infancy. The presence of IgM and IgG antibodies against parvovirus B19 is highly specific but their negativity is insufficient for the exclusion of a parvovirus B19 infection. Viral DNA testing by PCR method is the only reliable method available.

Key words:
parvovirus B19, fetal anemia, middle, Doppler, intrauterine growth retardation