Intrauterine management of fetal parvovirus B-19 infection

Objectives The aim of our study was to determine the outcome of pregnancies after intrauterine management of fetal parvovirus B-19 infection. Design Retrospective study. Subjects A total of 37 cases of maternofetal parvovirus B-19 infection, 35 of which were associated with hydrops fetalis, were referred to our tertiar y level center between 1989 and 1996. With regard to fetal hydrops, no appa rent cause other than parvovirus B-19 infection was found in any patient. Methods In all patients, cordocentesis was performed to assess the degree o f fetal anemia. When anemia was present, cordocentesis was followed by intr auterine transfusion with packed red cells into the umbilical vein. Further management depended on the degree of fetal anemia and gestational age and included follow-up fetal blood sampling/transfusion as well as ultrasound e xaminations as deemed appropriate. Results Packed red cell transfusion was performed in 30 patients with signi ficant fetal anemia (Z-score 1.6-7.8 below the mean for gestational age). T he fetal hemoglobin values ranged from 2.1 to 9.6 g/dl. Serum levels of pla telets in the transfusion group were 9-228 x 10(9)/l with Z-scores in the r ange of < 1 to 3.8 below the mean. During treatment and follow-up, there we re five intrauterine deaths (13.5%), one neonatal death (2.7%) and 31 live births (83.8%). Conclusions Fetal parvovirus infection can lead to marked anemia and hydrop s formation. Cordocentesis allows precise assessment of fetal anemia which can then be corrected by intravenous transfusion. Under this regimen, the o utcome proved favorable in the majority of fetuses, even those that were se verely anemic.