Marton T, Martin W L, Whittle M J
Department of Histopathology Birmingham Women's Hospital, Edgbaston, Birmingham, UK.
Prenat Diagn. 2005 Jul;25(7):543-5. doi: 10.1002/pd.1168.
A case of prenatally diagnosed human parvovirus B19 (HPVB19) infection is reported. The neonate died after intrauterine therapy and premature delivery. The fetus was diagnosed with oedema, cardiomegaly, poor myocardial contractility and a pericardial effusion at 24/40 weeks' gestation. Ultrasound using colour flow Doppler showed a midcerebral artery peak systolic velocity (MCA PSV) raised at 45 cm/s, suggesting fetal anaemia. This was confirmed on fetal blood sampling, but recovery was suggested with a reticulocyte count of 16.8%. The fetal karyotype was normal, 46,XY. Fetal IgM was positive for Parvovirus. A week later, severe fetal anaemia was suspected and intrauterine transfusion carried out. Altogether three transfusions were given. At 31/40 weeks, the mother presented to her local hospital with suspected preterm labour, a caesarean section was carried out because of fetal compromise on cardiotocography. The baby was in poor condition at birth and resuscitation was stopped at 45 min of age. The post-mortem examination confirmed the hydrops and proved persistent Parvovirus infection, cardiac involvement and severe liver fibrosis.HPVB19 generally follows a benign course with intrauterine therapy; however, in this case, the fetus died despite successful transfusions. The reasons for this are discussed.
本文报告了一例产前诊断为人细小病毒B19（HPVB19）感染的病例。该新生儿在宫内治疗和早产之后死亡。在妊娠24周时，胎儿被诊断为水肿、心脏肥大、心肌收缩力差和心包积液。彩色多普勒超声显示大脑中动脉收缩期峰值流速（MCA PSV）升高至45cm/s，提示胎儿贫血。胎儿血样检查证实了这一情况，但网织红细胞计数为16.8%，提示有恢复迹象。胎儿核型正常，为46,XY。胎儿IgM检测显示细小病毒呈阳性。一周后，怀疑胎儿出现严重贫血并进行了宫内输血。总共进行了三次输血。在妊娠31周时，母亲因疑似早产前往当地医院就诊，由于胎心监护显示胎儿窘迫，遂行剖宫产。婴儿出生时状况不佳，在出生45分钟时停止了复苏。尸检证实了水肿，并证明存在持续性细小病毒感染、心脏受累和严重肝纤维化。HPVB19感染经宫内治疗后通常病程呈良性；然而，在本病例中，尽管输血成功，胎儿仍死亡。本文对其原因进行了讨论。
