1
14 – 17 September 2014, Barcelona, Spain Electronic poster abstracts P02.14: Table 1. Cases Weeks at diagnosis Ultrasound findings Cyst (number) Karyotype Fetal sex Type of delivery Weight at birth (grams) Apgar 1/5 (minutes) pH 1 12 + 4 None 2 46XY Male Normal (Suctionpad) 2830 9/10 2 12 None 1 46XY Male Pending delivery 3 12 None 1 Female Normal 2640 9/10 7,33 4 16 4 None None 2 Male Normal 3440 9/10 7,35 2 Male Normal 3440 9/10 7,35 5 33 + 6 None 1 46XY Female Normal 3760 9/10 7,45 6 16 None 1 46XY 46XY Male Pending delivery Male Pending Delivery 3760 9/10 7,45 6 Pending delivery 7 32 None 1 Female Normal 3760 9/10 8 32 Triplet 1 3 Males Ces´ arean section 1571, 1400, 1100 9/10; 9/10; 6/9 9 12 Omphalocele Multiple Pending delivery 10 20 Choroid plexus cyst 1 Pending delivery 11 12 ISUA + bilateral pyelic ectasia + oligohydramnios 1 1 46XY TOP 46XY TOP 12 12 Hidrops fetalis + partial molar pregnancy Multiple TOP 13 11 + 6 Omphalocele + claw hands + choroid plexus cyst + EIUGR 1 18 TRISOMY Stillbirth 14 12 Mega-cystic bladder + holoprosencephaly + extremity malposition Multiple 18 TRISOMY TOP 15 12 Body wall complex/ body stalk anomaly 1 45X0 TOP 16 14 Oligohydramnios + partial molar pregnancy 1 TRIPLOIDY TOP TOP: termination of pregnancy. ISUA: Isolated single umbilical artery. EIUGR: Early intrauterine growth restriction. P02.16 Cause of fetal demise in first trimester parvovirus fetal infection: anemia or myocarditis? G.E. Chalouhi 1 , S. Benedetti 1 , C. Alby 1,2 , N. Benzina 1 , Y. Ville 1 1 Department of Obstetrics and Fetal Medicine, Necker-Enfants-Malades Hospital, APHP, Paris V University, Paris, France; 2 Department of Genetics-Pathology-Embryology and Cytogenetics, Necker-Enfants-Malades Hospital, APHP, Paris V University, Paris, France Increased nuchal translucency and/or fetal hydrops during first trimester ultrasound examination have been reported as signs of congenital infection with parvovirus infection. We report the case of a 35-year-old woman, gravida 3 para 2 with no prior relevant history who underwent routine US examination at 13 weeks’ by both dates and CRL (69 mm) and a nuchal translucency (NT) of 3.6 mm (>99th centile). The fetus was hydropic with generalized subcutaneous edema, pleural, and pericardial effusion as well as ascites. Hemodynamics assessment showed tricuspid regurgitation, and reverse flow in the umbilical artery. The MCA-PSV was 24.06 cm/s. Although the reference table of MCA-PSV doesn’t cover this early gestational age, fetal anemia was suspected. An intra-uterine spontaneous fetal demise was diagnosed 2 days later. Complemen- tary investigations were performed showing a normal karyotype, positive maternal IgG and IgM for Parvovirus B19, the virology analysis on amniocytes culture showed positive Parvovirus B19 DNA. Maternal Parvoviral seroconversion rate varies between 3-34% and the risk of vertical transmission is approximately 30%. Fetal hydrops develops in 0 to 12.5% of infected fetus with a peak at between between 17 and 24 weeks, while fetal demise is estimated to occur in 5-10%, with or without the diagnosis of fetal hydrops following an unclear physiopathology. Ultrasound in Obstetrics & Gynecology 2014; 44 (Suppl. 1): 181–369. 193

P02.16: Cause of fetal demise in first trimester parvovirus fetal infection: anemia or myocarditis?

  • Upload
    y

  • View
    216

  • Download
    3

Embed Size (px)

Citation preview

Page 1: P02.16: Cause of fetal demise in first trimester parvovirus fetal infection: anemia or myocarditis?

14–17 September 2014, Barcelona, Spain Electronic poster abstracts

P02.14: Table 1.

CasesWeeks atdiagnosis Ultrasound findings

Cyst(number) Karyotype

Fetalsex Type of delivery

Weight atbirth

(grams)Apgar 1/5(minutes) pH

1 12 + 4 None 2 46XY Male Normal(Suctionpad)

2830 9/10

2 12 None 1 46XY Male Pending delivery3 12 None 1 Female Normal 2640 9/10 7,334 16 4 None None

2 Male Normal3440 9/10 7,35

2 Male Normal 3440 9/10 7,35

5 33 + 6 None 1 46XY Female Normal 3760 9/10 7,456 16 None 1 46XY 46XY

MalePendingdelivery

Male PendingDelivery 37609/10 7,45 6Pendingdelivery

7 32 None 1 Female Normal 3760 9/108 32 Triplet 1 3 Males Cesarean section 1571,

1400,1100

9/10; 9/10;6/9

9 12 Omphalocele Multiple Pending delivery10 20 Choroid plexus cyst 1 Pending delivery11 12 ISUA + bilateral

pyelic ectasia +oligohydramnios

1 1 46XY TOP 46XY TOP

12 12 Hidropsfetalis + partialmolar pregnancy

Multiple TOP

13 11 + 6 Omphalocele + clawhands + choroidplexus cyst +EIUGR

1 18 TRISOMY Stillbirth

14 12 Mega-cysticbladder +holoprosencephaly+ extremitymalposition

Multiple 18 TRISOMY TOP

15 12 Body wall complex/body stalk anomaly

1 45X0 TOP

16 14 Oligohydramnios +partial molarpregnancy

1 TRIPLOIDY TOP

TOP: termination of pregnancy.ISUA: Isolated single umbilical artery.EIUGR: Early intrauterine growth restriction.

P02.16Cause of fetal demise in first trimester parvovirus fetalinfection: anemia or myocarditis?

G.E. Chalouhi1, S. Benedetti1, C. Alby1,2, N. Benzina1,Y. Ville1

1Department of Obstetrics and Fetal Medicine,Necker-Enfants-Malades Hospital, APHP, Paris V University,Paris, France; 2Department ofGenetics-Pathology-Embryology and Cytogenetics,Necker-Enfants-Malades Hospital, APHP, Paris V University,Paris, France

Increased nuchal translucency and/or fetal hydrops during firsttrimester ultrasound examination have been reported as signs ofcongenital infection with parvovirus infection.

We report the case of a 35-year-old woman, gravida 3 para2 with no prior relevant history who underwent routine US

examination at 13 weeks’ by both dates and CRL (69 mm) anda nuchal translucency (NT) of 3.6 mm (>99th centile). The fetuswas hydropic with generalized subcutaneous edema, pleural, andpericardial effusion as well as ascites. Hemodynamics assessmentshowed tricuspid regurgitation, and reverse flow in the umbilicalartery. The MCA-PSV was 24.06 cm/s.

Although the reference table of MCA-PSV doesn’t cover thisearly gestational age, fetal anemia was suspected. An intra-uterinespontaneous fetal demise was diagnosed 2 days later. Complemen-tary investigations were performed showing a normal karyotype,positive maternal IgG and IgM for Parvovirus B19, the virologyanalysis on amniocytes culture showed positive Parvovirus B19DNA.

Maternal Parvoviral seroconversion rate varies between 3-34%and the risk of vertical transmission is approximately 30%. Fetalhydrops develops in 0 to 12.5% of infected fetus with a peak atbetween between 17 and 24 weeks, while fetal demise is estimatedto occur in 5-10%, with or without the diagnosis of fetal hydropsfollowing an unclear physiopathology.

Ultrasound in Obstetrics & Gynecology 2014; 44 (Suppl. 1): 181–369. 193