Fetal myocarditis – a precursor of undesirable consequences of intrauterine infection with parvovirus B19

Authors

  • N. P. Bondarenko Bogomolets National Medical University, Kyiv, Ukraine,
  • V. M. Zhezhera OKHMATDYT, Kyiv, Ukraine,
  • A. V. Aksonova Bogomolets National Medical University, Kyiv, Ukraine,

DOI:

https://doi.org/10.14739/2310-1237.2019.1.166183

Keywords:

parvovirus В19 infection, pregnancy, non-immune hydrops fetalis, myocarditis

Abstract

Objective: to conduct a retrospective analysis of the results of sonographic, virological and morphological studies of cases of non-immune hydrops fetalis followed by intrauterine fetal death because of severe cardiovascular insufficiency (SCI) against parvovirus infection (PVI) with the aim of identifying signs of an adverse perinatal prognosis for the fetus. 

Object and methods. Infection of pregnant women was detected by serological diagnostics of specific antibodies IgM and IgG to parvovirus B19. Intrauterine fetal infection was confirmed by polymerase chain reaction (PCR). An antenatal diagnosis of hydrops fetalis was made using ultrasound scanning; intracranial hemodynamics, fetal myocardial hemodynamics and heart function were monitored using Doppler ultrasound with calculation of peripheral vascular resistance indices. The myocardium of human fetus was studied histologically with hematoxylin and eosin staining.

Results. In 15/33 (45.5 %) cases of infection with parvovirus B19 non-immune fetal hydrops was diagnosed in the II–III trimesters of pregnancy. The development of CVI, which arose secondary, against the background of myocarditis with/without fetal anemia (FA) was found in all the cases of fetal loss – 6/15 (40 %), in which the presence of parvovirus DNA in the pericardial effusion was proven after autopsy by the results of a polymerase chain reaction.

Conclusions. Myocarditis as a result of PVI promotes the emergence of CVI with the development of hydropericardium, has a fatal prognosis for the fetus, despite attempts to intrauterine blood transfusion in the III trimester. Fetal myocarditis against the background of non-immune fetal hydrops hinders timely non-invasive diagnosis of severe FA, is the cause of CVI which leads to extremely unfavorable consequences for the fetus.

 

References

Quigley, J., Doyle, B., Burke, E., Culliton, M., Diaz, M., & McParland, P. (2013) Non immune hydrops due to parvovirus B19 in pregnancy: a case report. Conference: International Society of Blood Transfusion 23rd Regional Congress of the ISBTAt, 150. Retrieved from https://www.giveblood.ie/Clinical-Services/Red-Cell-Immunohaematology-Diagnostics/RCI-Publications/non-immune-hydrops.pdf

Rice, P. (2014). Erythrovirus B19 (formerly known as parvovirus B19). Medicine, 42(1), 39–41. doi: https://doi.org/10.1016/j.mpmed.2013.10.011

Chen, C. C, Chen, C. S., Wang, W. Y., Ma, J. S., Shu, H. F., & Fan, F. S. (2015). Parvovirus B19 infection presenting with severe erythroid aplastic crisis during pregnancy in a woman with autoimmune hemolytic anemia and alpha-thalassemia trait: a case report. Journal of Medical Case Reports, 9, 58. doi: 10.1186/s13256-015-0542-7

Moreno, P., Bustos, D., Polo, J., Bonilla, J., & Parra-Medina, R. (2016). Miocarditis fetal por parvovirus B19. Repertorio De Medicina Y Cirugía, 25(2), 106–108. doi: 10.1016/j.reper.2016.03.001

Karabulut, A., Gök, S., & Koçyiğit, A. (2013). Non-immune hydrops fetalis without anemia due to parvovirus B19. International Journal of Gynecology & Obstetrics, 124(1), 82. doi: 10.1016/j.ijgo.2013.07.021

Hichijo, A., & Morine, M. (2014). A Case of Fetal Parvovirus B19 Myocarditis That Caused Terminal Heart Failure. Case Reports In Obstetrics And Gynecology, 2014, 463571. doi: 10.1155/2014/463571

Crane, J., Mundle, W., & Boucoiran, I. (2014). Parvovirus B19 Infection in Pregnancy. Journal of Obstetrics And Gynaecology Canada, 36(12), 1107–1116.

Mari, G. (2005). Middle cerebral artery peak systolic velocity for the diagnosis of fetal anemia: the untold story. Ultrasound In Obstetrics And Gynecology, 25(4), 323–330. doi: 10.1002/uog.1882

Mishalov, V. D., Voichenko, V. V., & Yurchenko, V. T. (Comp.). (2016). Poriadok vyluchennia biolohichnykh obiektiv vid pomerlykh osib, tila yakykh pidliahaiut sudovo-medychnii ekspertyzi, dlia naukovykh doslidzhen [The procedure for the removal of biological objects from dead persons, whose bodies are subject to forensic examination, for scientific research: (methodical recommendations)]. Kyiv. [in Ukrainian].

Kolobov, A. V., Karev, V. E., Vorobtsova, I. N., & Orel, V. I. (2013). Neimunnyj otek ploda pri vnutriutrobnoj infiekcii [Intrauterine infections with nonimmune hydrops fetalis]. Zhurnal infektologii, 5(2), 109–112. [in Russian].

How to Cite

1.
Bondarenko NP, Zhezhera VM, Aksonova AV. Fetal myocarditis – a precursor of undesirable consequences of intrauterine infection with parvovirus B19. Pathologia [Internet]. 2019May13 [cited 2024Nov.23];(1). Available from: http://pat.zsmu.edu.ua/article/view/166183

Issue

Section

Original research