Prenatal diagnosis of intrauterine cytomegalovirus infection in a fetus with non-immune hydrops fetalis

Abstract

Hydrops fetalis (HF) may be caused by a variety of nonim-munological conditions including intrauterine cytomegalovirus(CMV) infection. Cytomegalovirus may be isolated from amni-otic fluid for identification of CMV DNA by PCR. Detectionof CMV-specific IgM antibody in fetal blood sampling (FBS)is also highly suggestive of fetal infection. Here we present acase of intrauterine CMV infection diagnosed prenatally bysonography and serology from the percutaneous umbilicalblood sample and confirmed at postmortem by CMV DNAstudies in fetal blood and tissues.Half of the cases of hydrops fetalis are caused by Rhesushemolytic disease and the remaining half are caused by non-immunological conditions such as cardiac defects, arrhythmias,twin-to-twin transfusion syndrome, chromosomal abnormali-ties, infectious agents, inborn errors of metabolism, alpha thal-asemia, laryngeal atresia and severe fetomaternal hemorrhage.In one third of the cases the etiology is unknown (1–4).A variety of infectious agents have been associated with non-immune hydrops fetalis, most notably Parvovirus B19, cyto-megalovirus, herpes simplex virus, Toxoplasma gondii, aden-ovirus and Treponoma pallidum (5, 6). Cytomegalovirus hasbeen reported to be a causative agent in as many as 1.6% to 5%of ultrasonographically diagnosed cases of non-immune hy-drops (7).We would like to present a case of non-immune hydrops fe-talis caused by cytomegalovirus infection. Prenatal diagnosiswas established by serological tests in umbilical cord blood anddiagnosis was confirmed by detection of viral DNA in fetal