Background: Parvovirus B19 is known to cause fetal death in the second trimester, mainly in combination with hydrops fetalis. However, the frequency of parvovirus-B19-associated non-hydropic fetal loss in the late second and third trimester has not been thoroughly investigated. We aimed to investigate the frequency of parvovirus B19 infection in unselected cases of intrauterine fetal death and to assess the sensitivity of different diagnostic procedures.
Methods: Of 14147 deliveries in three hospitals in the major Stockholm area of Sweden, all cases of intrauterine fetal death (>22 gestational weeks) that occurred between January, 1998, and May, 1999 (n=47), referred cases of miscarriage (<22 gestational weeks, n=37), and induced abortions (n=29), were included in the study. Placental and fetal tissues were examined by means of parvovirus-B19-specific PCR, histopathology, and immunohistochemistry. Placental tissues from 53 normal pregnancies at term were also examined.
Findings: Significantly more cases of intrauterine fetal death were positive for parvovirus B19 DNA (seven [15%]) than were normal pregnancies at term (zero, p=0.049). Furthermore, parvovirus B19 DNA was found in two (5%) of the miscarriages but not in any of the cases of induced abortion. Only three of nine DNA-positive cases had parvovirus-B19-associated inclusions and stained positive for viral proteins. All but one of the DNA-positive cases of intrauterine fetal death were non-hydropic.
Interpretation: The presence of parvovirus B19 DNA in cases of late second-trimester and third-trimester fetal death is common, and most are non-hydropic. The sensitivity of conventional diagnostic procedures for intrauterine fetal death could be greatly improved by addition of parvovirus B19 PCR.