Atsuko Hichijo

A Case of Fetal Parvovirus B19 Myocarditis That Caused Terminal Heart Failure

Parvovirus B19 is a well-established cause of fetal anemia and nonimmune fetal hydrops in pregnancy. Fetal parvovirus infection can cause severe destruction of erythroid progenitor cells, resulting in fetal anemia, hydrops, and intrauterine death. However, viral myocarditis with subsequent heart failure is another possible mechanism for hydrops formation as viral infection of fetal myocardial cells has been reported in postmortem examinations. We herein report a case of fetal cardiomegaly and massive pericardial effusion secondary to myocarditis as a result of parvovirus B19 infection. The case developed hydrops as consequence of severe anemia and experienced terminal heart failure, which led to the fetus dying an intrauterine death at 22 weeks of gestation. This case demonstrates that there may be an association between myocarditis caused by intrauterine parvovirus B19 infection and a poor outcome. The presence of viral myocarditis may be the determining prognostic factor in that situation.

Effect of prolonged hospitalization for threatened preterm labor on maternal and fetal vitamin D levels

We aimed to evaluate the effect of prolonged hospitalization for threatened preterm labor (TPL) on maternal and fetal vitamin D status.

Three‐dimensional HDlive rendering of fetal perineum in anorectal atresia

Anorectal atresia (ARA) is a relatively common congenital malformation that is usually diagnosed by perineal inspection after birth1. HDlive is a new surface-rendering mode in ultrasound imaging which uses an adjustable light source to increase depth perception2,3. We present our experience of HDlive imaging for prenatal perineal inspection in a fetus with ARA. A 32-year-old Japanese woman, gravida 2, para 1, was referred to our institution at 31 + 1 weeks’ gestation because she wished to deliver in our hospital. Her pregnancy course was uneventful and firstand second-trimester sonographic examinations performed at another institution were reportedly unremarkable. An initial ultrasound examination of the fetus revealed moderate polyhydramnios, a small stomach, left renal dysplasia, mild lumbar kyphosis and a single umbilical artery. A tangential two-dimensional (2D) ultrasound scan of the fetal perineum revealed the absence of a perianal muscular complex (PAMC; Figure 1a). Three-dimensional (3D) HDlive imaging revealed a normal perineum but no anal dimple (Figure 1b). Thus, ARA was strongly suspected. Fetal echocardiography revealed pulmonary atresia with ventricular septal defect (VSD). Follow-up ultrasound at 33 weeks revealed an esophageal pouch in the neck, suggestive of esophageal atresia. These findings pointed towards a diagnosis of VATER association. A 2110-g female was delivered at 38 + 1 weeks’ gestation, with 1-min and 5-min Apgar scores of 7 and 8, respectively. Postnatal perineal inspection revealed ARA with a rectovestibular fistula (Figure 1c). Postnatal radiography