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Hydrops fetalis from B19 parvovirus infection
V L Katz1, N C Chescheir, M Bethea
1Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill 27599-7570.
Summary
Human parvovirus B19 infection can cause fetal hydrops and death. This case highlights unexplained maternal serum alpha-fetoprotein elevation preceding fetal myocarditis and hydrops, supporting parvovirus B19
Area of Science:
- Perinatology
- Virology
- Cardiology
Background:
- Human parvovirus B19 infection is a known risk factor for fetal hydrops and perinatal loss.
- Elevated maternal serum alpha-fetoprotein (MSAFP) can indicate fetal abnormalities, but its significance requires careful interpretation.
- Fetal myocarditis has been implicated in some cases of parvovirus B19-associated hydrops fetalis.
Purpose of the Study:
- To document a case of unexplained elevated MSAFP with normal amniotic fluid AFP.
- To investigate the potential role of fetal myocarditis in the absence of placental inflammation.
- To further support the association between parvovirus B19 infection and fetal myocardial involvement.
Main Methods:
- Case report documentation.
- Antenatal surveillance including ultrasound.
- Histologic examination of fetal tissues.
Main Results:
- Unexplained elevation of maternal serum alpha-fetoprotein with normal amniotic fluid alpha-fetoprotein was observed.
- Fetal hydrops and death occurred more than 14 weeks after suspected maternal exposure.
- Antenatal and histologic findings suggested fetal myocarditis preceded hydrops, consistent with parvovirus B19 infection.
Conclusions:
- This case supports the hypothesis that fetal myocarditis, potentially due to parvovirus B19 infection, can precede hydrops fetalis.
- Unexplained MSAFP elevation warrants further investigation, especially in the context of potential fetal infections.
- Parvovirus B19 should be considered in cases of fetal myocarditis and hydrops, even without clear placental inflammation.