In utero treatment of severe fetal anaemia due to parvovirus B19 in one fetus in a twin pregnancy--a case report and literature review.

BACKGROUND

Parvovirus B19 (PVB19) is a well-established cause of nonimmune hydrops fetalis and fetal anaemia in pregnancy. However, discordant viral infection of only 1 fetus in a twin pregnancy is a rare occurrence.

CASE REPORT

A 40-year-old female with dichorionic, diamniotic twin pregnancy presented at 22 weeks with fetal hydrops and severe anaemia in 1 twin. Maternal PVB19 infection was confirmed, and the affected fetus was treated with a single intrauterine transfusion. The only subsequent complication developed was that the affected fetus was growing on the 5th centile. The affected twin continued to grow, and 2 live twins were delivered by caesarean section at 36 weeks. By 18 months of age, the affected twin had normal development.

CONCLUSION

PVB19 may selectively affect 1 fetus in a dichorionic, diamniotic twin pregnancy and may be treated efficiently with intrauterine transfusion. Discordant viral infection in this case suggests that the viral load may be limited to 1 placenta and/or that different individual immunological fetal response starts very early in utero.