ABSTRACT
OBJECTIVES: To determine rates of fetal anaemia and pregnancy outcome in susceptible pregnant women infected with human parvovirus B19 infection in a tertiary fetal medicine department over a 7-year period. Additional features enabling identification of fetuses that progress to severe anaemia were also investigated. METHODS: Forty-seven susceptible, pregnant women with confirmed parvovirus infection referred to a regional fetal medicine unit, over a 7-year period (1999-2006), were identified. Where possible maternal serum AFP measurements were obtained from second-trimester serum screening and the presence or absence of echogenic bowel noted. RESULTS: Of the 47 cases, one was excluded. Of the remaining 46 cases, 34 (74%) showed no signs of fetal anaemia and delivered at term. The remaining 12 (26%) showed signs of fetal anaemia. Eight of the 12 developed hydrops and underwent fetal blood sampling and transfusion (median pretransfusion Hb 3.6 g/dl). Seven of the 8 transfused fetuses were thrombocytopenic with a platelet count <150 x 10(9)/l, with 2 fetuses having platelet counts <50 x 10(9)/l. The median gestation age at transfusion was 22 weeks (range 18-27 weeks). The median number of weeks between seroconversion and transfusion was 6 (range 3-12). The signs of anaemia resolved after one transfusion in 5 of the 8 transfused fetuses and they subsequently delivered at term. There were 2 fetal deaths during or shortly after transfusion and one neonatal death following delivery at 28 weeks gestation due to severe pre-eclampsia, 5 days after successful transfusion. CONCLUSIONS: Following parvovirus seroconversion, the incidence of significant fetal anaemia requiring transfusion was 17%. Seroconversion after 21 weeks did not result in severe fetal anaemia. Significant anaemia requiring intervention did not occur 12 weeks after maternal seroconversion. We did not demonstrate a correlation with either maternal serum AFP or the presence of fetal echogenic bowel and the development of severe fetal anaemia. Because of the association between fetal anaemia and severe thrombocytopenia, it may be prudent to have compatible platelets available at the time of fetal blood sampling.
Subject(s)
Anemia/therapy , Blood Transfusion, Intrauterine , Parvoviridae Infections/therapy , Parvovirus B19, Human/pathogenicity , Pregnancy Complications, Infectious/virology , Thrombocytopenia/therapy , Anemia/diagnosis , Anemia/embryology , Anemia/virology , Biomarkers/blood , Female , Fetal Death , Gestational Age , Humans , Hydrops Fetalis/therapy , Hydrops Fetalis/virology , Infant, Newborn , Intestines/diagnostic imaging , Intestines/embryology , Middle Cerebral Artery/diagnostic imaging , Middle Cerebral Artery/embryology , Parvoviridae Infections/diagnosis , Parvoviridae Infections/embryology , Parvoviridae Infections/virology , Pregnancy , Pregnancy Outcome , Retrospective Studies , Severity of Illness Index , Thrombocytopenia/diagnosis , Thrombocytopenia/embryology , Thrombocytopenia/virology , Treatment Outcome , Ultrasonography, Doppler , Ultrasonography, Prenatal , alpha-Fetoproteins/metabolismABSTRACT
BACKGROUND: A frequent dilemma for obstetricians is how to keep morbidity to a minimum when faced with arrested progress at full dilatation of the cervix. Our aim was to examine maternal and neonatal morbidity associated with vaginal instrumental delivery in theatre and caesarean section, at full dilatation. METHODS: We did a prospective cohort study of 393 women, who had term, singleton, liveborn, cephalic pregnancies requiring operative delivery in theatre at full dilatation for 1 year. FINDINGS: Factors increasing the likelihood of caesarean section included maternal body-mass index greater than 30 (adjusted odds ratio 2.4, 95% CI 1.2-4.9), neonatal birthweight greater than 4.0 kg (2.3, 1.3-3.8), and occipitoposterior position (2.5, 1.6-3.9). Women undergoing caesarean section were more likely to have a major haemorrhage (>1 L; 2.8, 1.1-7.6) and extended hospital stay (>/=6 days; 3.5, 1.6-7.6) than those with vaginal delivery. Babies delivered by caesarean section were more likely to require admission for intensive care (2.6, 1.2-6.0) but less likely to have trauma (0.4, 0.2-0.7) than babies delivered by forceps. Overall neonatal morbidity was low, but a few babies in each group had serious complications (serious trauma, eight vs three; sepsis, six vs 13; and jaundice, ten vs 12 after vaginal delivery and caesarean section, respectively). Major haemorrhage was less likely after delivery by a skilled obstetrician (0.5, 0.3-0.9). INTERPRETATION: The data lend support to an aim to deliver women vaginally, unless there are clear signs of cephalopelvic disproportion, and underline the importance of skilled obstetricians supervising complex operative deliveries.
