Hepatitis-B-virus-infection of the mother as a cause of fetal nonimmune hydrops fetalis

A 16-year-old primigravida was referred to our department at 22 weeks gesta tion because of a nonimmune hydrops fetalis. Sonography revealed an isolate d fetal ascites. Cordocentesis was performed to rule out anaemia, infection and chromosomale abnormalities, followed subsequently by intrauterine tran sfusion because of fetal anaemia (hemoglobin-concentration of 8.4 g/dl). It was found that the pregnant suffered from an acute hepatitis-B-virus-inf ection with positive HBsAg, positive HBeAg and HBc-IgM antibodies, confirme d by serological tests. In a second cordocentesis the cordblood specimen was found to be HBsAg posi tive as well. The fetus was intramusculary given hyperimmune-globulin under ultrasound guidance. In the further course of pregnancy signs of meconium-peritonitis were obser ved. Postnatally a distal ilcal perforation was detected and the newborn un derwent laparotomy for distal ileal perforation. In this case report we dis cuss the connection with nonimmune hydrops fetalis and the maternal and fet al hepatitis-B-virus-infection.