Pustilnik T B, Cohen A W
Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia.
Obstet Gynecol. 1994 May;83(5 Pt 2):834-6.
Parvovirus infection has been associated with the development of nonimmune hydrops fetalis in pregnancy. This report describes a twin pregnancy in which one fetus was affected by parvovirus B19 and the other was not.
A 35-year-old woman was found to have a twin gestation at genetic amniocentesis. Subsequent ultrasound at 18 weeks showed that twin B had evidence of hydrops fetalis. Serum from the mother tested positive for parvovirus B19 immunoglobulin (Ig) G and IgM. Cultured amniotic fluid from twin B was subsequently found to be positive for parvovirus B19. At 20 weeks' gestation, the hydropic fetus died. The unaffected fetus grew normally. At 40 weeks, the unaffected fetus was delivered vaginally with no difficulties. Cord blood from the unaffected fetus was negative for parvovirus B19 IgM.
This case demonstrates differential infection of parvovirus B19 in a diamniotic, dichorionic twin pregnancy. One twin developed signs of hydrops fetalis consistent with parvovirus B19. The diagnosis was confirmed immunologically and by amniotic fluid culture. The second twin had no evidence of parvovirus B19 and no immunologic suggestion of infection at birth. This is the only known report of such differential transmission of parvovirus B19 in a twin pregnancy.
细小病毒感染与妊娠期非免疫性胎儿水肿的发生有关。本报告描述了一例双胎妊娠，其中一个胎儿感染了细小病毒B19，另一个未感染。
一名35岁女性在遗传羊膜穿刺术中被发现怀有双胎妊娠。18周时的后续超声检查显示，双胎B有胎儿水肿的迹象。母亲的血清检测显示细小病毒B19免疫球蛋白（Ig）G和IgM呈阳性。随后发现双胎B的羊水培养物细小病毒B19呈阳性。妊娠20周时，水肿胎儿死亡。未受影响的胎儿正常生长。妊娠40周时，未受影响的胎儿经阴道顺利分娩。未受影响胎儿的脐带血细小病毒B19 IgM呈阴性。
本病例显示了双绒毛膜双羊膜囊双胎妊娠中细小病毒B19的差异感染。其中一个双胎出现了与细小病毒B19一致的胎儿水肿迹象。通过免疫学和羊水培养确诊。第二个双胎没有细小病毒B19感染的证据，出生时也没有感染的免疫学迹象。这是双胎妊娠中已知的唯一一例细小病毒B19如此差异传播的报告。
