Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin Nan Lu, Chengdu, Sichuan Province, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, No. 20, Section 3, Renmin Nan Lu, Chengdu, Sichuan Province, China.
J Int Med Res. 2024 Oct;52(10):3000605241283633. doi: 10.1177/03000605241283633.
Maternal hepatitis virus has rarely been implicated in fetal meconium peritonitis (FMP), and its underlying mechanism is largely unknown. We describe a case of FMP presumably caused by maternal chronic hepatitis B virus (HBV). A 29-year-old primigravid woman was referred to our hospital at 35 weeks of gestation for the disappearance of fetal movements. The maternal prenatal history included HBV for more than 10 years. Her HBV DNA level was suppressed (<20 IU/mL) and she was taking oral tenofovir disoproxil fumarate (300 mg/day). At 21 weeks, fetal ascites, echogenic bowel, and intra-abdominal calcifications were observed by abdominal ultrasound. These findings were confirmed by magnetic resonance imaging and were regarded as diagnostic for FMP. Cord blood and amniotic fluid were positive for hepatitis B e antigen and hepatitis B surface antigen. Ascites of the FMP was completely self-absorbed at 27 weeks. At 35 weeks of gestation, fetal movements had vanished and male stillbirth was induced. A histopathological examination of the placenta showed meconium uptake by macrophages in the amniochorionic membranes. Our findings suggest that maternal HBV can cross the placenta and induce FMP. Close surveillance may allow an early diagnosis of FMP and prevent fetal mortality.
母源性肝炎病毒很少与胎儿胎粪性腹膜炎（FMP）相关，其潜在机制在很大程度上尚不清楚。我们描述了一例可能由母源性慢性乙型肝炎病毒（HBV）引起的 FMP 病例。一名 29 岁初产妇因胎动消失被转诊至我院，其母产前病史包括 HBV 感染 10 余年。其 HBV DNA 水平被抑制（<20IU/mL），并正在服用口服替诺福韦酯（300mg/天）。在 21 周时，腹部超声检查发现胎儿腹水、肠回声增强和腹腔内钙化。这些发现通过磁共振成像得到了证实，并被认为是 FMP 的诊断依据。脐血和羊水均检测到乙型肝炎 e 抗原和乙型肝炎表面抗原阳性。FMP 的腹水在 27 周时完全自行吸收。在 35 周妊娠时，胎动消失，导致男性死产。胎盘的组织病理学检查显示胎粪被羊膜绒毛膜中的巨噬细胞摄取。我们的研究结果表明，母源性 HBV 可以穿过胎盘并引发 FMP。密切监测可能有助于早期诊断 FMP 并防止胎儿死亡。
