Influence of gestational age and fetal heart rate on the fetal mechanical PR interval.

OBJECTIVE: The fetal mechanical PR interval obtained via pulsed Doppler has previously been demonstrated to correlate with electrocardiographic PR interval measured in the neonate. We sought to further analyze the influence of fetal heart rate and gestational age upon the fetal mechanical PR interval. METHODS: We searched our database for mechanical PR intervals, which were obtained during fetal echocardiography performed in our antenatal diagnostic unit. We included fetuses with a normal cardiac structural survey. The mechanical PR interval is measured from the A wave of the mitral valve to the beginning of ventricular systole corresponding to the opening of the aortic valve. Linear regression curves were generated to examine the correlation of mechanical PR interval with gestational age and fetal heart rate. Analysis of variance was used to compare the mean variation across three gestational age groups: 17-21.9 weeks (n = 24), 22-25.9 weeks (n = 52) and 26-38 weeks (n = 20). RESULTS: Mechanical PR intervals were measured in 96 fetuses with normal fetal echocardiography. The mechanical PR interval was 123.9 +/- 10.3 ms (mean +/- SD), with a range of 90-150 ms. Linear regression curves correlating mechanical PR interval with fetal heart rate and gestational age demonstrated a flat slope with R2 = 0.016, p = 0.22 and R2 = 0.0004, p = 0.85, respectively. The mechanical PR interval measured over the three gestational ages was as follows (mean +/- SD): 122.3 +/- 10.5 ms for 17-21.9 weeks; 125.0 +/- 9.6 ms for 22-25.9 weeks; and 123.1 +/- 11.9 ms for 26-38 weeks. Analysis of variance revealed no difference among the mechanical PR interval means measured over the three gestational age groups (p = 0.53). CONCLUSIONS: Fetal mechanical PR interval ranges from 90 to 150 ms in fetuses with sonographically normal fetal cardiac structure and rate. The mechanical PR interval appears to be independent of gestational age and fetal heart rate.

Maternal and neonatal morbidity after elective repeat Cesarean delivery versus a trial of labor after previous Cesarean delivery in a community teaching hospital.

OBJECTIVE: To compare maternal and fetal outcomes after elective repeat Cesarean section versus a trial of labor in women after one prior uterine scar. STUDY DESIGN: All women with a previous single low transverse Cesarean section delivered at term with no contraindications to vaginal delivery were retrospectively identified in our database from January 1995 to October 1998. Outcomes were first analyzed by comparing mother-neonate dyads delivered by elective repeat Cesarean section to those undergoing a trial of labor. Secondarily, outcomes of mother-neonatal dyads who achieved a vaginal delivery or failed a trial of labor were compared to those who had elective repeat Cesarean delivery. RESULTS: Of 1408 deliveries, 749/927 (81%) had a successful vaginal birth after a prior Cesarean delivery. There were no differences in the rates of transfusion, infection, uterine rupture and operative injury when comparing trial of labor versus elective repeat Cesarean delivery. Neonates delivered by elective repeat Cesarean delivery were of earlier gestation and had higher rates of respiratory complications (p < 0.05). Mother-neonatal dyads with a failed trial of labor sustained the greatest risk of complications. CONCLUSION: Overall, neonatal and maternal outcomes compared favorably among women undergoing a trial of labor versus elective repeat Cesarean delivery. The majority of morbidity was associated with a failed trial of labor. Better selection of women likely to have a successful vaginal birth after a prior Cesarean delivery would be expected to decrease the risks of trial of labor.

Cost analysis of Down syndrome screening in advanced maternal age.

OBJECTIVE: To analyze the potential cost and efficacy of Down syndrome screening in the population with advanced maternal age. METHODS: Three screening methods defining Down syndrome risk for women with advanced maternal age were analyzed: advanced maternal age; advanced maternal age and maternal serum triple screen; and advanced maternal age, maternal serum triple screen and genetic sonogram. Costs for all tests and procedures were estimated. Procedure-related loss for amniocentesis was assumed to be 1:200. Efficacy was defined as: number of amniocenteses performed, number of Down syndrome cases detected, procedure-related losses, Down syndrome cases detected per fetal loss, cost per Down syndrome case detected and total cost of screening. RESULTS: In 1999 in the USA, there were 530,610 women with advanced maternal age at 16 weeks' gestation carrying an estimated 4,043 fetuses with Down syndrome. Screening by maternal age alone would result in the 100% detection of Down syndrome cases, but would require over 530,000 amniocenteses and result in 2,653 procedure-related losses. Combining age with serum screen and genetic sonogram would detect 97.6% of Down syndrome cases, but would require only 119,791 amniocenteses and result in 599 procedure-related losses. The projected cost per Down syndrome case detected using age screening is 219,109 dollars versus 155,992 dollars using serum screen and genetic sonogram. CONCLUSIONS: The combination of advanced maternal age, maternal serum screen and genetic sonogram would result in the fewest procedure-related losses and lowest cost per Down syndrome case detected.

Extreme second-trimester serum analyte values in down syndrome pregnancies with hydrops fetalis.

OBJECTIVE: To compare second-trimester maternal serum analyte values in Down syndrome pregnancies with, and without, hydrops fetalis. METHODS: Seven hydropic and 85 non-hydropic Down syndrome pregnancies were identified among women with positive second-trimester maternal serum screening results. Values for maternal serum alpha-fetoprotein (MSAFP), human chorionic gonadotropin (hCG), unconjugated estriol and inhibin-A, and risks for Down syndrome were compared using the non-parametric Mann-Whitney statistical test. RESULTS: Hydropic Down syndrome pregnancies had significantly lower MSAFP and estriol concentrations, while hCG levels were higher. For subgroups of five hydropic and 42 non-hydropic cases, no statistically significant difference in the inhibin-A levels could be demonstrated. CONCLUSION: Second-trimester Down syndrome screening risks are significantly higher in affected pregnancies that are complicated by fetal hydrops.

Role of ultrasound for Down syndrome screening in advanced maternal age.

OBJECTIVE: To determine the sensitivity and false-positive rate of Down syndrome screening by use of maternal serum screen and the genetic sonogram in women > or =35 years of age. STUDY DESIGN: We searched our perinatal databases retrospectively from January 1992 to January 2000 for the following criteria: known Down syndrome fetus or newborn, advanced maternal age, and genetic sonogram from 14-24 weeks' gestation. The a priori maternal age or maternal serum screen risk was modified by likelihood ratios for ultrasound markers. Without markers the risk was reduced by 50%. The cut-off was 1:270. RESULTS: Age and maternal serum screen had a sensitivity of 90.5% and a false-positive rate of 27.1%. Age and ultrasound had a 95.2% sensitivity and 43.5% false-positive rate, whereas the combination of age, maternal serum screen, and ultrasound had a 97.6% sensitivity and a 22.0% false-positive rate. CONCLUSION: The combination of age, maternal serum screen, and ultrasound improves the sensitivity for Down syndrome detection in the advanced maternal age population.

Is an isolated fetal cardiac echogenic focus an indication for fetal echocardiography?

OBJECTIVE: To determine whether the presence of an isolated fetal cardiac echogenic focus should be an indication for fetal echocardiography. METHODS: We reviewed our fetal echocardiography and obstetrics databases from January 1992 through July 1999. The study groups were formulated from patients referred for fetal echocardiography. Patients referred for echocardiography because of a single isolated fetal cardiac echogenic focus were compared with patients referred for other indications. The sensitivity, specificity, and positive and negative predictive values were calculated for an isolated echogenic focus as a marker for structural cardiac abnormalities as detected by fetal echocardiography. RESULTS: Of 10,406 fetuses seen for ultrasonography, 1908 had fetal echocardiography. Cardiac abnormalities were identified in 3.4% (65 of 1908) of the fetuses that had echocardiography. The prevalence of an isolated echogenic focus was 2.2% (230 of 10,406) and was the indication in 12.1% (230 of 1908) of our echocardiograms. Only 1 of the 230 fetuses with an isolated echogenic focus had a structural cardiac defect (membranous ventricular septal defect). An isolated echogenic focus as a marker for congenital cardiac defects resulted in sensitivity and specificity of 1.5% and 87.6%, respectively. The positive and negative predictive values were 0.4% and 96.2%, respectively The relative risk for an echogenic focus in predicting congenital cardiac defects was 0.11 (95% confidence interval, 0.02-0.82). CONCLUSIONS: An isolated fetal cardiac echogenic focus is not an efficacious marker for congenital cardiac defects. It should not be the sole indication for fetal echocardiography.

Evaluation and follow-up of fetal hydronephrosis.

OBJECTIVE: To determine the antenatal course and neonatal follow-up of isolated fetal hydronephrosis. METHODS: We reviewed our ultrasonography database from January 1989 to June 1999 for all cases of unilateral or bilateral fetal hydronephrosis that had at least 1 follow-up ultrasonographic examination. Cases were defined as mild, moderate, or severe depending on the renal pelvis anteroposterior diameter and gestational age. Data were analyzed using the chi2 test with the Fisher exact test where appropriate. Medical records were reviewed, and telephone interviews were performed to determine which infants received follow-up after birth. RESULTS: Of 57,966 ultrasonographic examinations in 20,049 women during the study period, 393 patients met criteria for evaluation. Of these, 347 (88%) had fetuses with mild hydronephrosis. Most of these had complete resolution during the pregnancy. Forty patients had fetuses classified as having moderate hydronephrosis, and 6 patients had fetuses with severe hydronephrosis. Of those classified as moderate hydronephrosis, 15% resolved, 25% improved, 48% remained unchanged, and 12% worsened during the pregnancy. There were no cases of in utero resolution in the severe group; however, 4 of 6 cases improved to moderate or mild, and 2 cases remained unchanged. Of the cases identified prenatally, 25 received consultation by a pediatric urologist in the newborn period, and 7 of these required surgical intervention. CONCLUSIONS: Our population-based data suggest that most cases of mild hydronephrosis will resolve before delivery. In contrast, cases of moderate or severe hydronephrosis are less likely to have resolution in utero and are more likely to worsen or remain unchanged. Of those fetuses with persistent hydronephrosis, only a small number required some surgical intervention after birth. This information is useful in counseling the patient whose fetus is noted to have isolated hydronephrosis.

Second trimester maternal serum analytes in triploid pregnancies: correlation with phenotype and sex chromosome complement.

Second trimester maternal serum alpha-fetoprotein (MS-AFP), human chorionic gonadotrophin (hCG), unconjugated estiol (uE3), and inhibin-A (INH-A) levels were evaluated in pregnancies complicated by triploidy. In addition to seven new triploid pregnancies, the results for 67 published cases were reviewed. All cases appear to fall into two major groups. First, those identifiable as screen-positive for both Down syndrome and an open neural tube defect (ONTD) with elevated MS-AFP, grossly elevated hCG, low/normal uE3, and probably elevated INH-A. Pregnancies in the second group are identifiable as screen-positive for trisomy 18 with low/normal MS-AFP, and very low hCG, uE3 and INH-A. Triploid pregnancies with high maternal serum hCG nearly always show a placenta with partial mole (25/27 or 93%), a high frequency of ONTDs or ventral wall defects (VWDs) (8/28 or 29%) and have either an XXX or XXY karyotype (observed ratio 6:10, respectively). Low hCG is infrequently associated with a molar placenta (1/11 or 9%), does not appear to be associated with ONTDs or VWDs (0/29 or 0%), and shows an excess of XXX over XXY karyotypes (observed ratio 17:2). There were 16 cases with either a molar placenta, an ONTD or a VWD that received the MS-AFP and hCG tests. All 16 were screen-positive for an ONTD (MS-AFP> or =2 multiples of the median). In addition, all 31 cases that received MS-AFP, hCG, uE3 (and where available INH-A) were screen-positive for either Down syndrome or trisomy 18. The findings are discussed in the context of expected differences between digynic and diandric triploidy. It is suggested that the sex chromosome complement in triploidy is an important factor in determining risk for partial mole development and in utero survival.

Estimates for the sensitivity and false-positive rates for second trimester serum screening for Down syndrome and trisomy 18 with adjustment for cross-identification and double-positive results.

Second trimester screening for fetal Down syndrome and trisomy 18 is available through separate protocols that combine the maternal age-specific risk and the analysis of maternal serum markers. We have determined the extent to which additional Down syndrome affected pregnancies may be identified through trisomy 18 screening, and the extent to which additional cases of trisomy 18 may be screen-positive for Down syndrome. The combined false-positive rate, taking into consideration those pregnancies that are screen-positive by both protocols, has also been determined. Sensitivity and false-positive rates were determined by computer simulation of results that incorporated previously published statistical variables into the model. Using second trimester risk cut-offs of 1:270 for Down syndrome and 1:100 for trisomy 18, it was found that few additional cases of Down syndrome are identified through trisomy 18 screening. However, approximately 6-10% of trisomy 18 affected pregnancies will be screen-positive for Down syndrome but screen-negative for trisomy 18. For women aged 40 or more, the false-positive rate for trisomy 18 exceeds 1% and approximately half of these cases will also be screen-positive for Down syndrome. For a population with maternal ages equivalent to that in the United States in 1998, after adjusting for the cross-identification, the sensitivity for three-analyte trisomy 18 screening is 78%. If this testing is performed in conjunction with Down syndrome "triple" screening, the Down syndrome sensitivity is 75% and the combined false-positive rate is 8.5%. If the three-analyte trisomy 18 screening is performed with the Down syndrome "quad" screen, the trisomy 18 sensitivity remains at 78%, the Down syndrome sensitivity is 79%, and combined false-positive rate is 7.5%. Sensitivity and false-positive rates are also provided for other widely used Down syndrome and trisomy 18 risk cut-offs. Sensitivity and false-positive rates that take into consideration cross-identification and double-positives should be helpful for pre-test counseling and the evaluation of serum screening programs.

Efficacy of screening for fetal Down syndrome in the United States from 1974 to 1997.

OBJECTIVE: To estimate the 16-week prevalence of Down syndrome in the United States from 1974 to 1997 and to determine the efficacy of maternal age cutoffs and triple screens for detecting it antenatally. METHODS: Using natality statistics for the United States from 1974 to 1997 of maternal-age-specific live births to women 13-49 years old, we evaluated advanced maternal age (35-49 years at delivery) and the triple serum test (maternal serum alpha-fetoprotein, hCG, and unconjugated estriol) as screening tests for Down syndrome. Efficacy was evaluated using sensitivity, false-positive rate, positive predictive value, and likelihood ratio (likelihood ratio = sensitivity/false-positive rate). RESULTS: In 1974, the estimated second-trimester prevalence of Down syndrome was one in 740, but by 1997 that had increased to one in 504. The proportion of Down syndrome fetuses at 16 weeks' gestation in women 35-49 years old increased from 28.5% in 1974 to 47.3% in 1997. However, live births to women 35-49 years old increased more rapidly from 4.7% in 1974 to 12.6% in 1997. The likelihood ratio for maternal age to identify an affected pregnancy decreased during the study period and was substantially lower than that using the serum test. CONCLUSION: A maternal age cutoff of 35 years in the 1990s resulted in high false-positive rates and was less efficacious based on likelihood ratio and positive predictive value. Serum testing of all pregnant women would reduce the number of amniocenteses and decrease procedure-related losses.

Outcome of pregnancies complicated by ruptured membranes after genetic amniocentesis.

OBJECTIVE: We sought to compare perinatal outcomes of pregnancies complicated by preterm premature rupture of membranes after genetic amniocentesis with pregnancies complicated by spontaneous preterm premature rupture of membranes at a similar gestational age. STUDY DESIGN: A retrospective study was performed in which a computerized database was reviewed to identify all patients presenting to our institution with preterm premature rupture of membranes within 48 hours of a genetic amniocentesis from July 1988 to August 1999. Control subjects were matched for gestational age at preterm premature rupture of membranes. Patients were all managed expectantly. Outcomes were compiled from review of medical records. Descriptive statistics, the Student t test, and the chi(2) test were used, with P <.05 considered significant. RESULTS: During the study period, genetic amniocentesis was performed 1101 times. Eleven (1%) women presented within 48 hours with preterm premature rupture of membranes. The mean gestational age at the time of rupture was not different between the cases in which preterm premature rupture of membranes occurred after genetic amniocentesis compared with the control subjects in whom preterm premature rupture of membranes occurred spontaneously (16.5 weeks vs 17.6 weeks, respectively). Women with preterm premature rupture of membranes after amniocentesis experienced significantly longer latency periods (124 vs 28 days; P =.0001) and delivered at more advanced gestational ages (34.2 vs 21.6 weeks; P =.0002) than those with spontaneous preterm premature rupture of membranes. The perinatal survival rate was 91% in pregnancies complicated by preterm premature rupture of membranes after genetic amniocentesis compared with a rate of 9% in control subjects (P =.005). CONCLUSIONS: Pregnancies complicated by preterm premature rupture of membranes after genetic amniocentesis result in significantly better perinatal outcomes compared with pregnancies complicated by spontaneous preterm premature rupture of membranes at a similar gestational age. Expectant management should be considered in such cases.

Comprehensive fetal ultrasonographic growth measurements in triplet gestations.

OBJECTIVE: Our purpose was to create tables and graphs of ultrasonographically derived fetal growth parameters in longitudinally studied triplet gestations from a single center. STUDY DESIGN: All triplet pregnancies managed by our division from 1987 through 1998 were identified. All had first-trimester dating sonograms and complete obstetric sonograms obtained by means of 3.5- or 5.0-MHz curvilinear transducers with freeze-freeze capability and on-screen calipers. Sonograms to assess fetal growth were obtained every 2 to 4 weeks, from 16 to 18 weeks' gestation until delivery. Fetal parameters obtained with each sonogram included biparietal diameter; head circumference; bicerebellar diameter; abdominal circumference; femur, humerus, tibia, and fibula lengths; estimated fetal weight; and head circumference/abdominal circumference ratio. Regression analysis was performed with JMP and Cricket Graph software packages, and lines of best fit with 95% confidence intervals were generated. RESULTS: A total of 443 ultrasonographic examinations were performed for 33 triplet pregnancies (99 fetuses). Each had between 3 and 6 sonograms obtained, all between 16 and 35 weeks' gestation. Scatterplots of each of the fetal growth parameters against gestational age were created with regression lines of best fit and 95% confidence intervals. All growth parameters were dependent on gestational age. CONCLUSION: A comprehensive set of fetal growth measurements in triplets from the United States is now available and can be used to assess longitudinal fetal growth.

Different population dynamics of human T cell lymphotropic virus type II in intravenous drug users compared with endemically infected tribes.

The phylogeny of human T cell lymphotropic virus type II (HTLV-II) was investigated by using strains isolated from Amerindian and Pygmy tribes, in which the virus is maintained primarily through mother-to-child transmission via breast-feeding, and strains from intravenous drug users (IDUs), in which spread is mainly blood-borne via needle sharing. Molecular clock analysis showed that HTLV-II has two different evolutionary rates with the molecular clock for the virus in IDUs ticking 150-350 times faster than the one in endemically infected tribes: 2.7 x 10(-4) compared with 1.71/7.31 x 10(-7) nucleotide substitutions per site per year in the long terminal repeat region. This dramatic acceleration of the evolutionary rate seems to be related with the mode of transmission. Mathematical models showed the correlation of these two molecular clocks with an endemic spread of HTLV-II in infected tribes compared with the epidemic spread in IDUs. We also noted a sharp increase in the population size of the virus among IDUs during the last decades probably caused by the worldwide increase in intravenous drug use.

High rate of human T lymphotropic virus type IIa infection in HIV type 1-infected intravenous drug abusers in Ireland.

Serological and molecular analyses of a cohort of HIV-1-infected intravenous drug abusers (IVDAs) (n = 103) in Dublin, Ireland have demonstrated that 15 of 103 (14.6%) were infected with HTLV-II, which is the highest infection rate yet recorded for any European country. Restriction fragment length polymorphism (RFLP) analysis of the env region of the provirus demonstrated that the infection involved only the HTLV-IIa subtype; the HTLV-IIb subtype was not detected. Phylogenetic analysis of the nucleotide sequences of the long terminal repeat (LTR) confirmed infection with the HTLV-IIa subtype, and demonstrated that the viruses clustered closely with HTLV-IIa isolates from North American IVDAs. Previous observations that IVDAs in southern Europe, specifically Spain and Italy, appear to be infected predominantly with the HTLV-IIb subtype, along with the present report and evidence that IVDAs in Sweden are infected with the HTLV-IIa subtype, suggest different origins of HTLV-II infection in Europe.

Relationship of amniotic fluid markers of intra-amniotic infection with histopathology in cases of preterm labor with intact membranes.

OBJECTIVE: To evaluate the correlation of amniotic fluid (AF) markers (AFMs) of intra-amniotic infection with histopathologic findings in cases of preterm labor with intact membranes, between 22 and 36 weeks' gestation. STUDY DESIGN: We reviewed the charts of patients admitted in preterm labor with intact membranes between January 1993 and December 1996. Those having amniocentesis were identified, and AFMs were compared with histopathology in patients who delivered within 48 hours of the amniocentesis. The AFMs evaluated were glucose, polymorphonuclear leukocytes, Gram stain, and culture. All placentae were reviewed by a single pathologist blinded to the AF findings. Histologic evidence of acute inflammation was defined by findings of both subchorial intervillositis and marginating choriodeciduitis. The sensitivities, specificities, and positive and negative predictive values of the various AFMs were calculated. RESULTS: Of 556 women with intact membranes presenting in preterm labor, 181 (32.6%) had amniocentesis and 88 delivered within 48 hours of the amniocentesis. Histopathologic chorioamnionitis was seen in 53 patients (60.2%). The findings (with their sensitivity, specificity, and positive and negative predictive values) were: polymorphonuclear leukocytes at > 10/high-power field (22.6%, 97.2%, 92.3%, and 46.1%), positive Gram stain (26.4%, 94.6%, 87.5%, and 47.3%), culture (28.3%, 92.1%, 83.3%, and 47.9%), and glucose of < 15 mg/dl (28.3%, 94.6%, 88.2%, and 47.9%), respectively. Using a receiver-operator characteristic curve for different level of AF glucose, a glucose level of < 20 mg/dl was the most sensitive AF predictor of histologic chorioamnionitis. CONCLUSION: Histopathologic evidence of chorioamnionitis was present in 60.2% of cases of preterm births due to preterm labor in women who at our institution were offered and accepted amniocentesis and subsequently delivered within 48 hours. AFMs may be useful predictors of histologic chorioamnionitis. The most efficient AFM for chorioamnionitis in this group of patients was glucose at < 20 mg/dl.

Clinical and ultrasonographic features of dextroposition of the fetal heart.

OBJECTIVE: Our purpose was to characterize the findings associated with dextroposition of the fetal heart. STUDY DESIGN: A fetal echocardiography database was retrospectively searched from January 1990 through December 1996 to identify all cases referred or diagnosed with dextroposition of the fetal heart. Dextroposition was defined as most of the normally connected fetal heart found on the right side of the fetal chest. Intracardiac and extracardiac fetal anomalies were reviewed. All available karyotypes and postnatal examinations were reviewed. RESULTS: During the study period 2882 fetal echocardiograms were performed, of which 297 (10.3%) were abnormal. Of these, 14 had dextroposition. Associated anomalies included atrioventricular canal (29%), diaphragmatic hernia (21%), and aneuploidy (14%). Isolated dextroposition with no other significant anomalies was seen in only 1 case. In another, no anomalies were noted except for suspected agenesis of 1 lobe of the right lung; karyotype and postnatal evaluation revealed no other abnormalities in both cases. CONCLUSIONS: Dextroposition of the fetal heart was seen in 0.5% of our fetal echocardiograms and was associated with significant anomalies in 86% of our cases. When diagnosed, a targeted ultrasonogram, fetal echocardiogram, and karyotype should be offered.

Management of parvovirus infection in pregnancy and outcomes of hydrops: a survey of members of the Society of Perinatal Obstetricians.

OBJECTIVE: Our purpose was to investigate the evaluation and management of parvovirus infection during pregnancy. STUDY DESIGN: Surveys were mailed to members of the Society of Perinatal Obstetricians residing in the United States and Canada in July 1997. They were asked about their evaluation and management of parvovirus infection, including whether they repeated and confirmed serologic studies, what their initial and follow-up evaluations included, whether they had had any cases of parvovirus-associated hydrops in the past 2 years, and if so, what were the management and outcomes of the hydropic fetuses. RESULTS: Surveys were mailed to 1623 members of the Society of Perinatal Obstetricians and 541 completed surveys were returned. Sixty-eight percent of the respondents repeated and confirmed serologic studies. Eighty-nine percent used ultrasonography in their initial management of pregnant patients with recent parvovirus infection, 7.5% used amniocentesis for polymerase chain reaction, and 2% used fetal blood sampling. The outcomes of the 539 cases of parvovirus-induced hydrops included spontaneous resolution in 34%, death without intrauterine transfusion in 30%, resolution after intrauterine transfusion in 29%, death after intrauterine transfusion in 6%, and pregnancy termination in 1%. Almost all cases of nonimmune hydrops reported occurred between 16 and 32 weeks. CONCLUSIONS: Approximately one third of the cases of parvovirus-induced nonimmune hydrops resolved spontaneously, whereas 83.5% of hydropic fetuses transfused survived.

Fetal hydrops in the first trimester associated with maternal parvovirus infection.

We present a case of fetal hydrops associated with maternal parvovirus infection during the first trimester of pregnancy that sonographically mimicked findings associated with fetal aneuploidy. The transabdominal sonograms of this fetus at 12.9 weeks' gestational age were consistent with increased nuchal translucency thickness. Transvaginal sonographic evaluation of the fetus showed generalized subcutaneous sonolucency suggestive of early fetal hydrops. An etiologic evaluation identified serologic evidence of recent maternal parvovirus infection and a normal karyotype. The pregnancy ended in fetal demise. Our findings suggest that visualization of nuchal translucency thickening in the first trimester should prompt a complete sonographic evaluation for fetal hydrops, which, if identified, should lead to serologic evaluation for parvovirus infection.