Infection with parvovirus B19 and the maternal, mirror syndrome: A case report

In 2024, an extreme increase in the number of parvovirus B19 (B19V) infections occurred worldwide, including in the pregnant population, resulting in severe foetal morbidity and mortality. We describe the case of a 37-year-old patient (G2/P1) who was 26 weeks 0 days pregnant at admission and who presented with foetal hydrops and mirror syndrome due to B19V infection and sudden onset of acute perimyocarditis in the mother, possibly triggered by the foetal situation and severe anaemia. Foetal hydrops is a life-threatening manifestation of foetal infection with B19V. Independent of whether it is immune or nonimmune, hydrops fetal is occurs in 1 : 1500 to 4000 pregnancies. In 6.1% of foetal hydrops cases, the hydrops mirrors the symptoms between the mother and the child. Mirror syndrome was defined as foetal hydrops and/or placentomegaly associated with the maternal development of pronounced oedema with or without preeclampsia symptoms. Due to the increase in infections and the potentially foetal consequences for the unborn child, the possible therapy, which requires well coordinated multidisciplinary cooperation, is relevant for anaesthesiologists as demonstrated in the following case. The patient underwent two foetal transfusions and one foetal ascites puncture; consequently, she required anaesthesiological care on multiple occasions. We emphasise the importance of ensuring that patients with this condition are closely monitored, not only by the obstetrician but also by the anaesthesiologist, so that the clinical deterioration of the mother and/or the child can be quickly recognised and treated appropriately.