Grubman Olivia, Hussain Farrah Naz, Nelson Zoe, Brustman Lois
Department of Obstetrics and Gynecology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY 10019, USA.
Case Rep Obstet Gynecol. 2019 Jul 7;2019:3259760. doi: 10.1155/2019/3259760. eCollection 2019.
This is a case report of a 31-year-old primigravida who was diagnosed with an asymptomatic acute parvovirus B19 infection in the second trimester of pregnancy and its suspected association with an increased nuchal translucency (NT) measurement. Parvovirus B19 is a single-stranded DNA virus that is cytotoxic to erythroid progenitor cells, causing inhibition of erythropoiesis. While maternal disease is usually mild, fetal infection can result in spontaneous abortion, aplastic anemia, nonimmune fetal hydrops, and fetal demise. This fetus had an increased NT of 3.2 mm at 11 weeks' gestation with a normal male karyotype and microarray analysis on chorionic villi sampling, in addition to a normal fetal echocardiogram at 15 weeks' gestation. The anatomy scan at 20 weeks' and 1-day gestation revealed fetal ascites, pleural effusion, and increased middle cerebral artery peak systolic velocity suspicious for fetal anemia. At this time, maternal serology for parvovirus was positive for IgM and IgG. Amniocentesis, cordocentesis, and intrauterine transfusion were performed. The amniocentesis revealed elevated parvovirus B19 DNA, quantitative PCR (2,589,801 copies/mL, reference range <100 copies/mL). The patient delivered a viable male fetus at 37 weeks' and 6-day gestation, without sequelae of the previously noted hydrops. Parvovirus B19 infection should be a consideration when evaluating increased NT and hydrops fetalis. It warrants close antepartum surveillance and possible intrauterine fetal transfusions. With prompt recognition, proper treatment, and surveillance, these patients can go on to achieve healthy term deliveries. Long-term outcomes of delivered infants require further study.
这是一例31岁初产妇的病例报告，该患者在妊娠中期被诊断为无症状急性B19细小病毒感染，并怀疑其与颈项透明层（NT）测量值增加有关。B19细小病毒是一种单链DNA病毒，对红系祖细胞具有细胞毒性，可导致红细胞生成受到抑制。虽然母体疾病通常较轻，但胎儿感染可导致自然流产、再生障碍性贫血、非免疫性胎儿水肿和胎儿死亡。该胎儿在妊娠11周时NT值增加至3.2 mm，核型为正常男性，绒毛取样的微阵列分析结果正常，此外，妊娠15周时胎儿超声心动图也正常。妊娠20周零1天时的解剖扫描显示胎儿有腹水、胸腔积液，大脑中动脉收缩期峰值速度增加，怀疑有胎儿贫血。此时，母体B19细小病毒血清学检测IgM和IgG均为阳性。进行了羊膜腔穿刺术、脐血穿刺术和宫内输血。羊膜腔穿刺术显示B19细小病毒DNA升高，定量PCR检测结果为2,589,801拷贝/mL（参考范围<100拷贝/mL）。患者在妊娠37周零6天时分娩出一名存活男婴，之前发现的水肿未留下后遗症。在评估NT增加和胎儿水肿时应考虑B19细小病毒感染。这需要进行密切的产前监测并可能进行宫内胎儿输血。通过及时识别、适当治疗和监测，这些患者可以实现健康足月分娩。分娩婴儿的长期结局需要进一步研究。
