Fetal hydrops in the first trimester associated with maternal parvovirus infection

Parvovirus B19 belongs to the Parvoviridae family, Erythrovirus type, and it presents cytotoxicity on the erythroblast human line leading to severe anemia. We present the case of a 35-year-old woman, at the 3rd pregnancy, with a first trimester abortion in her history and a physiological birth, who presented to the specialty check-up at 20 gestational weeks, associating the signs of a respiratory infection, without any other pathologies until this gestational age. The laboratory tests and the fetal ultrasound did not point out any pathological elements, therefore the patient was sent home with the recommendation to come back after 2 weeks for reevaluation, when the fetal ultrasound revealed fetal hydrops and severe anemia, and after 24 hours fetal asystole. Maternal serology pointed out recent infection with Parvovirus B19. The particularity of this case consists in the appearance of relative rare fetal infection in the second trimester of pregnancy in the case of a physiological, monitored pregnancy, with unfavorable prognosis and fulminant death towards intrauterine death.

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Maternal Parvovirus B19 Infection Causing First-Trimester Increased Nuchal Translucency and Fetal Hydrops

Case Reports in Obstetrics and Gynecology ◽

10.1155/2019/3259760 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Olivia Grubman ◽

Farrah Naz Hussain ◽

Zoe Nelson ◽

Lois Brustman

Keyword(s):

Parvovirus B19 ◽

Peak Systolic Velocity ◽

First Trimester ◽

Nuchal Translucency ◽

Normal Male ◽

Fetal Hydrops ◽

Erythroid Progenitor ◽

Parvovirus B19 Infection ◽

Male Karyotype ◽

Increased Nuchal Translucency

This is a case report of a 31-year-old primigravida who was diagnosed with an asymptomatic acute parvovirus B19 infection in the second trimester of pregnancy and its suspected association with an increased nuchal translucency (NT) measurement. Parvovirus B19 is a single-stranded DNA virus that is cytotoxic to erythroid progenitor cells, causing inhibition of erythropoiesis. While maternal disease is usually mild, fetal infection can result in spontaneous abortion, aplastic anemia, nonimmune fetal hydrops, and fetal demise. This fetus had an increased NT of 3.2 mm at 11 weeks’ gestation with a normal male karyotype and microarray analysis on chorionic villi sampling, in addition to a normal fetal echocardiogram at 15 weeks’ gestation. The anatomy scan at 20 weeks’ and 1-day gestation revealed fetal ascites, pleural effusion, and increased middle cerebral artery peak systolic velocity suspicious for fetal anemia. At this time, maternal serology for parvovirus was positive for IgM and IgG. Amniocentesis, cordocentesis, and intrauterine transfusion were performed. The amniocentesis revealed elevated parvovirus B19 DNA, quantitative PCR (2,589,801 copies/mL, reference range <100 copies/mL). The patient delivered a viable male fetus at 37 weeks’ and 6-day gestation, without sequelae of the previously noted hydrops. Parvovirus B19 infection should be a consideration when evaluating increased NT and hydrops fetalis. It warrants close antepartum surveillance and possible intrauterine fetal transfusions. With prompt recognition, proper treatment, and surveillance, these patients can go on to achieve healthy term deliveries. Long-term outcomes of delivered infants require further study.

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Fetal supraventricular tachycardia at 12 weeks of gestation: diagnosis and follow up. A case report

Medical Ultrasonography ◽

10.11152/mu-1617 ◽

2019 ◽

Vol 21 (1) ◽

pp. 93 ◽

Cited By ~ 2

Author(s):

Nathalie Jeanne Bravo-Valenzuela ◽

Alberto Borges Peixoto ◽

Edward Araujo Júnior ◽

Gabriele Tonni

Keyword(s):

Sinus Rhythm ◽

Supraventricular Tachycardia ◽

Fetal Heart ◽

First Trimester ◽

Ventricular Rate ◽

Healthy Male ◽

Fetal Hydrops ◽

Male Baby ◽

Digoxin Therapy

This report describes a case of fetal supraventricular tachycardia (SVT) diagnosed at 12 weeks of gestation in a pregnant woman with diabetes mellitus. Transplacental digoxin therapy administered orally to the mother was unsuccessful. Subsequently, sotalol was added to digoxin to achieve fetal heart rate (HR) control and the conversion to sinus rhythm was achieved. The fetal HR remained stable until term, and a healthy male baby was born. The newborn electrocardiogram showed sinus rhythm with normal PR and QTc intervals. When the newborn was stable, he was discharged with propanolol. Sustained SVT is extremely rare during the first trimester. The goal of treatment in utero is the conversion to sinus rhythm or reduction of the ventricular rate to tolerable levels, preventing or even reversing fetal hydrops.

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A Case of Thanatophoric Dysplasia Type I with Fetal Hydrops in the First Trimester

Case Reports in Obstetrics and Gynecology ◽

10.1155/2016/1821230 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Giannina Calongos ◽

Masateru Hori ◽

Mai Ogino ◽

Hideaki Sawai

Keyword(s):

Normal Karyotype ◽

First Trimester ◽

Type I ◽

Long Bones ◽

Thanatophoric Dysplasia ◽

Fetal Hydrops ◽

Cervical Dilation ◽

Skeletal Disease ◽

Skeletal Radiography ◽

Strong Suspicion

During a routine prenatal exam, a 36-year-old female in her third pregnancy was diagnosed with fetal hydrops at 11 weeks of gestation. The pregnancy was monitored with periodic ultrasounds; however, spontaneous resolution was not observed. Amniotic fluid examination at 16 weeks of gestation showed a normal karyotype; however, macrocephaly, a narrow thorax, and shortening of the long bones were observed on ultrasonography. With the strong suspicion of a fetal skeletal disease, specifically thanatophoric dysplasia (TD), and after extensive genetic counseling, termination of the pregnancy was performed per the parents’ wishes with mechanical cervical dilation and gemeprost (PGE1) administration. Following delivery, the fetus was found to have macrocephaly, a narrow bell-shaped thorax, and a protuberant abdomen, as well as curved long bones, H-shaped platyspondyly, and curved clavicles on skeletal radiography. As a result, the fetus was diagnosed with TD type I. This case illustrates that although TD is a rare disease, an accurate prenatal diagnosis can be made with the use of ultrasonography.

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Recurrent Cystic Hygroma with Normal Karyotype in Two Consecutive Pregnancies

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2016.486 ◽

2016 ◽

Author(s):

Nil Şahin Uysal ◽

Çağrı Gülümser ◽

Filiz Bilgin Yanık

Keyword(s):

Autosomal Recessive ◽

Fetal Echocardiography ◽

Normal Karyotype ◽

First Trimester ◽

Cystic Hygroma ◽

Recessive Trait ◽

Fetal Hydrops ◽

Previous Pregnancy ◽

Chorion Villus ◽

Nonimmune Hydrops

We herein describe a woman with two consecutive pregnancies affected by fetal nuchal cystic hygroma (CH) with a normal karyotype. A 33-year-old woman (gravidity 2, parity 1) was referred to us because of fetal hydrops. No consanguinity or Rh isoimmunization was involved in her current or previous pregnancy. First-trimester ultrasonography revealed nuchal CH, and chorion villus sampling was performed to exclude aneuploidy. In the first pregnancy, the CH had regressed and aortic coarctation was detected by second-trimester fetal echocardiography. In the current pregnancy, the CH had progressed and was complicated by the development of nonimmune hydrops. Termination of the pregnancy was performed at 21 weeks’ gestation. Recurrence of fetal CH in subsequent pregnancies is extremely rare. CH with a normal karyotype can be inherited as an autosomal recessive trait. This report describes a woman with recurrent CH with normal karyotypes and different prognoses

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A hemizygous mutation in the FOXP3 gene (IPEX syndrome) resulting in recurrent X-linked fetal hydrops: a case report

BMC Medical Genomics ◽

10.1186/s12920-021-00901-6 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Panicos Shangaris ◽

Alison Ho ◽

Andreas Marnerides ◽

Simi George ◽

Mudher AlAdnani ◽

...

Keyword(s):

Third Space ◽

First Trimester ◽

Pathological Process ◽

Gene Variants ◽

Fetal Hydrops ◽

Case Presentation ◽

Intrauterine Life ◽

Fatal Course ◽

Immunodeficiency Syndrome ◽

Underlying Pathology

Abstract Background Fetal hydrops is excessive extravasation of fluid into the third space in a fetus, which could be due to a wide differential of underlying pathology. IPEX (immune dysregulation, polyendocrinopathy, enteropathy, X-linked) syndrome primarily affects males. It is a monogenic primary immunodeficiency syndrome of X-linked recessive inheritance due to FOXP3 gene variants. It is characterised by the development of multiple autoimmune disorders in affected individuals. Case presentation We present a rare cause of male fetal hydrops in the context of IPEX syndrome and discuss FOXP3 gene variants as a differential for ‘unexplained’ fetal hydrops that may present after the first trimester. Discussion and conclusions In all similar cases, the pathological process begins during intrauterine life. Furthermore, there are no survivors described. Consequently, this variant should be considered as a severe one, associated with intrauterine life onset and fatal course, i.e., the most severe IPEX phenotype.

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