Parvovirus B19 - a cause of non-hydropic third trimester intrauterine fetal death

Abstract

Objective: Parvovirus В19 or fifth disease is a common viral disease. Clinical symptoms are rash, fever, and sometimes arthralgia. The virus can also affect bone marrow, liver, and heart muscle. — In pregnancy, the virus can cause fetal anaemia, hydrops, and fetal death, mainly during the second trimester. In a prospective study of pregnant women В19 antibodies were found in 60% as a sign of previous infection. One of the women, with no antibodies for Parvovirus В19, suffered an intrauterine fetal death (IUFD) at 37 gestational weeks (GW). There were no hydropic changes. Parvovirus В19 DNA was found in the placenta and in maternal serum at delivery as well as three weeks before the fetal demise. In Danderyd Hospital an extensive protocol for investigation of IUFD has been in use for many years. By this protocol approximately 45% of the IUFDs can be explained.

Full Text

Method: Since 1992 all women with IUFD have been investigated for Parvovirus В19, IgG and IgM in maternal serum and В19 DNA in serum and placenta. These tests have been added to the former protocol for IUFD.During the years 1992-1998 there were 33 759 deliveries including 93 cases of third trimester IUFD at Danderyd Hospital.

Results: Among the 93 cases of IUFD, 7 (7.5%) had detectable В19 DNA in placental tissue. None of the infants was hydropic. No other explanation for the fetal death was found. В19 IgG was positive in maternal serum in 5 cases. In one case seroconversion took place between 2 and 6 months after delivery (when samples were collected); in one case В19 IgG was negative still 8 months post partum.

Conclusion: In all cases of third trimester IUFD testing for Parvovirus В19 should be performed, both serological tests and tests for В19 DNA.