Leung Tse Ngong, Leung Tak Yeung, Chan Paul Kay Sheung, Fung Tak Yuen, Lau Tze Kin
Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong.
J Reprod Med. 2007 May;52(5):419-21.
Parvovirus B19 infection during pregnancy is a known cause of nonimmune hydrops, while about one third of maternal infection is asymptomatic. Spontaneous abortion, hydrops fetalis, intrauterine growth retardation and meconium peritonitis are possible manifestations of fetal infection, but the infection can also be asymptomatic.
Both fetuses in a dichorionic, diamniotic twin pregnancy were infected with parvovirus B19 infection, but only 1 fetus presented with hydrops fetalis. That fetus died, while the other remained asymptomatic throughout the pregnancy. The mother had a normal delivery at 39 weeks of gestation, and the neonatal outcome of the surviving twin was normal apart from early-onset neonatal jaundice due to ABO incompatibility.
This case, together with others, illustrates that parvovirus B19 infection in twin fetuses can present differently despite the fact that the fetuses are nurtured in rather similar intrauterine environments. A severe complication in 1 twin does not preclude a normal outcome in the other. The possibility of different manifestations should be borne in mind so that parvovirus B19 infection remains high on the list of differential diagnoses of nonimmune hydrops affecting only 1 fetus in a twin pregnancy.
孕期感染细小病毒B19是已知的非免疫性水肿的病因，而约三分之一的母体感染是无症状的。自然流产、胎儿水肿、宫内生长受限和胎粪性腹膜炎是胎儿感染的可能表现，但感染也可能无症状。
双绒毛膜、双羊膜囊双胎妊娠中的两个胎儿均感染了细小病毒B19，但只有1个胎儿出现胎儿水肿。该胎儿死亡，而另一个胎儿在整个孕期均无症状。母亲在妊娠39周时顺产，存活双胎的新生儿结局正常，仅因ABO血型不合出现早发性新生儿黄疸。
本病例及其他病例表明，尽管双胎胎儿在相当相似的宫内环境中发育，但细小病毒B19感染在双胎胎儿中的表现可能不同。一个双胎出现严重并发症并不排除另一个双胎有正常结局。应牢记不同表现的可能性，以便在双胎妊娠中仅1个胎儿出现非免疫性水肿的鉴别诊断清单上，细小病毒B19感染仍居前列。
