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We report the case of a pregnant lady who had hydrops fetalis in three successive pregnancies and discuss the possible genetic causes and the systematic approach to evaluation of her pregnancy and her future reproductive options. Hydrops fetalis can occur due to a heterogeneous number of causes. Systematic evaluation helps in determining the cause which then determines the prognosis as well as recurrence in future pregnancies. Recurrent hydrops though rare, can occur because of single gene defects causing hematological, neurological, cardiac conditions, etc. Genetic testing and consideration of the role of exome sequencing is important in counseling families regarding their future pregnancy options as well as to offer prenatal diagnosis.

Fetal supraventricular tachycardia management is challenging, with consequences for both the fetus and the mother. If left untreated, fetal hydrops may ensue, at which point delivery and treatment of the arrhythmia is preferred. However, if the fetus is not at term nor near-term, significant doses of antiarrhythmics may be needed to achieve adequate transplacental bioavailability. Although digoxin has classically been the mainstay of treatment, the use of flecainide or sotalol as monotherapy or in combination with digoxin is being studied. Interdisciplinary team management and shared decision-making between the physician and patient are key to achieving successful outcomes. Adult cardiologists, particularly inpatient consultation services or through burgeoning cardio-obstetrics programs, may, in some practice settings, be asked to evaluate or co-manage pregnant women with fetal arrhythmia.

Background Mirror syndrome (MS) is a rare obstetric disorder complicated with high maternal morbidity and fetal mortality. MS is often misdiagnosed or underdiagnosed due to the low incidence and lack of awareness of its diverse features. This study aimed to summarise the etiology, clinical characteristics, and risk factors of MS among mothers with fetal hydrops. Methods This retrospective case-control study included 37 pregnant women with fetal hydrops in the second and third trimesters from 58,428 deliveries performed at the Third Affiliated Hospital of Sun Yat-Sen University between January 2012 and December 2020. Cases were categorized as MS and non-MS according to the presence or absence of maternal mirroring symptoms. Binary logistic regression was performed for analysis. Results Fourteen women developed MS with an overall incidence of 0.024% (14/58,428) and 37.8% (14/37) in the fetal hydrops cases. Among the 11 MS cases with known associated etiologies, seven had alpha thalassemia major. Onset of fetal hydrops was later (27.8 vs. 23.0 weeks) and the rate of placental thickening was higher (85.7% vs. 34.8%) in the MS group than in the non-MS group (P P Conclusions MS is relatively common among fetal hydrops cases in the late second and third trimesters, and alpha thalassemia major is the main etiology for fetal hydrops and also MS in this population. Complicated with high maternal morbidity, the key maternal features of MS include more weight gain, hemodilution, and hypertension. Among those with fetal hydrops, the onset time of ≥24 weeks and placental thickening are risk factors for MS.

We present a special case of fetal supraventricular tachycardia detected at 34 weeks gestation. Fetal hydrops was noted on ultrasound upon admission. Normal fetal heart rate was maintained for three weeks by maternal administration of digoxin. A live infant was delivered via caesarian section at 37 weeks gestation. This clinical case demonstrated that pharmacological treatment can be effective and helps to prolong pregnancy safely.

Placental chorioangioma (CA) is a benign placental tumor. No specific treatment is required for asymptomatic cases. We report a female infant born to a mother with giant placental CA. However fetal growth was normal and, fetal hydrops was not detected by ultrasound examination until delivery, she had hydrops, subgaleal hematoma, thrombocytopenia, hemolytic anemia, respiratory distress and circulatory failure after birth. She was successfully treated without any neurological sequelae. At 2 months of age, infantile hemangioma appeared in her lower lip. The present case suggested that giant placental CA might cause postnatal problems and be associated with the development of infantile hemangioma.

Mirror syndrome (MS) or Ballantyne’s syndrome is a rare maternal condition that can be life-threatening for both mother and fetus. The condition is characterized by maternal signs and symptoms similar to those seen in preeclampsia in the setting of fetal hydrops. Despite recent advances in the field of maternal-fetal medicine, the etiopathogenesis of MS remains elusive. For patients and doctors, the COVID-19 pandemic has become an extra hurdle to overcome. The following case illustrates how patients’ non-compliance associated with mirror syndrome and SARS-CoV-2 infection led to the tragic end of a 19-year-old patient. Therefore, knowledge of the signs and symptoms of mirror syndrome should always be part of the armamentarium of every obstetrician.

Sustained fetal supraventricular tachycardia (SVT) complicated by hydrops fetalis carries a significant risk of morbidity and mortality. While there is no clear consensus on first- and second-line therapy options for the management of fetal SVT with or without hydrops fetalis, there exists significant nonrandomized experience with a number of antiarrhythmic agents that has founded the basis for management. Furthermore, recently published meta-analyses and ongoing multicenter prospective studies have aimed to bridge the gap in the literature. We report two cases of sustained fetal SVT with severe secondary hydrops fetalis managed successfully with flecainide-sotalol combination therapy in one case and sotalol-digoxin combination therapy in the second and review the literature for the management of fetal SVT.

Rhesus-conflict is a pathological condition that manifests itself in the formation of antibodies against fetal erythrocytes in the body of pregnant woman due to the incompatibility of maternal and fetal Rh-factors. The main causes of morbidityand mortality in rhesus conflict are intrauterine hemolytic anemia, fetal hydrops, hemolytic neonatal disease. In addition, an important factor contributing to the increase in perinatal losses in this pathology is the high birth rate of extremely immature children. The reason for this is a preterm labor induction in case of a threat to the life of the fetus, as well as premature births associated with a variety of fetal manipulations. The number of cases of this pathology has declined dramatically throughout the world over the last decades, due to the widespread coverage of women at risk of immunization (anti-D - immunoglobulin). Unfortunately, in Ukraine this situation is not uncommon to this day.The article covers the main modern views on the causes, pathogenesis, course and prevention of immunological conflict associated with incompatibility of the Rh factor in terms of evidence-based medicine. The article describes the experience gained during recent years and attempts to unify the prognostic and preventive approaches in this area.Conclusions:1. Rhesus-conflict remains a serious problem of domestic medicine with a significant contribution to perinatal loss.2. Proper and timely anti-Rh immune prophylaxis among all non-immunized women can significantly reduce the incidence of severe disease in fetuses and newborns.3. There are no remedies for Rhesus conflict. Treatment is subjected to severe hemolytic disease only that occurs before the fetal maturity. Intrauterine hemotransfusion allows prolonging such pregnancy and preventing antenatal fetal death., Резус-конфликт – это патологическое состояние, которое проявляется образованием в организме беременной антител против эритроцитов плода в связи с несовместимостью материнского и плодового резус-факторов. Основными причинами заболеваемости и смертности при резус-конфликте является внутриутробная гемолитическая анемия, водянка плода, гемолитическая болезнь новорожденных. Кроме того, важным фактором, способствующим росту перинатальных потерь при данной патологии, является высокий уровень рождения крайне незрелых детей. Причина этого – родоразрешение на ранних сроках в случае угрозы для жизни плода, а также преждевременные роды, связанные с различными фетальными манипуляциями. Количество случаев данной патологии резко уменьшилось во всем мире в течение последних десятилетий благодаря широкому охвату женщин группы риска иммунопрофилактикой (антирезусный иммуноглобулин). К сожалению, в Украине это состояние не является редкостью и по сей день.В статье освещены основные современные взгляды на причины возникновения, патогенез, течение и профилактику иммунологического конфликта, связанного с несовместимостью по резус-фактору, с точки зрения доказательной медицины. В материале изложен опыт, приобретенный в течение последних лет и предпринята попытка унификации прогностических и профилактических подходов по данной проблематике.Выводы:1. Резус-конфликт остается серьезной проблемой отечественной медицины со значительным вкладом в перинатальные потери.2. Правильное и своевременное проведение анти-резус иммунопрофилактики всех неиммунизированных женщин способно существенно уменьшить частоту случаев тяжелых проявлений гемолитической болезни плодов и новорожденных.3. Не существует способов лечения резус-конфликта. Лечению подлежит только тяжелая гемолитическая болезнь, возникающая до момента зрелости плода. Внутриутробные гемотрансфузии позволяют пролонгировать такую беременность и профилактировать антенатальную гибель плода., Резус-конфлікт є патологічним станом, що проявляється утворенням в організмі вагітної антитіл проти еритроцитів плода в зв’язку з несумісністю материнського та плодового резус-факторів. Основними причинами захворюваності та смертності при резус-конфлікті є внутрішньоутробна гемолітична анемія, водянка плода, гемолітична хвороба новонароджених. Окрім того, важливим фактором, який сприяє зростанню перинатальних втрат за даної патології, є високий рівень народження вкрай незрілих дітей. Причина цього – розродження на ранніх термінах у випадку загрози для життя плода, а також передчасні пологи, пов’язані з різноманітними фетальними маніпуляціями. Кількість випадків даної патології різко зменшилася в усьому світі протягом останніх десятиліть завдяки широкому охопленню жінок групи ризику імунопрофілактикою (антирезусний імуноглобулін). На жаль, в Україні цей стан не є рідкістю й донині.У статті висвітлено основні сучасні погляди на причини виникнення, патогенез, перебіг і профілактику імунологічного конфлікту, пов’язаного з несумісністю за резус-фактором, з точки зору доказової медицини. У матеріалі викладено досвід, набутий протягом останніх років і здійснено спробу уніфікації прогностичних та профілактичних підходів за даною проблематикою.Висновки:1. Резус-конфлікт залишається серйозною проблемою вітчизняної медицини зі значним внеском у перинатальні втрати.2. Правильне та вчасне проведення анти-резус імунопрофілактики серед усіх неімунізованих жінок здатне суттєво зменшити частоту випадків важких проявів гемолітичної хвороби плодів і новонароджених.3. Не існує засобів лікування резус-конфлікту. Лікуванню підлягає лише важка гемолітична хвороба, що виникає до моменту зрілості плода. Внутрішньоутробні гемотрансфузії дозволяють пролонгувати таку вагітність і профілактувати антенатальну загибель плода.

Cytomegalovirus is the most common congenital viral infection. Infection can cause developmental delay, sensorineural deafness and fetal death. Fetal damage is more severe when infection occurs in the first trimester of pregnancy. Prenatal ultrasound findings may be cerebral, such as ventriculomegaly, microcephaly and periventricular leukomalacia, as well as non-cerebral, such as echogenic bowel, ascites and pericardial effusion. We present a case of congenital cytomegalovirus infection in which the only ultrasound sign noted at routine second-trimester scan was low-grade echogenic bowel, a soft marker, which progressed to severe disease in the third trimester, when further investigation was prompted, leading to the diagnosis. Patients need to be counselled regarding the possible perinatal prognosis. Ultrasound markers can often but not always predict severity and, hence, counselling can be a challenge. Conclusion: A meticulous anatomy survey in mid-trimester remains the norm and ultrasound soft markers should prompt comprehensive testing for viral infections in pregnancy., Highlights • Fetal damage caused by infection with CMV is more severe when the infection occurs in the first trimester of pregnancy. • CMV is the most common congenital viral infection causingdevelopmental delay, sensorineural deafness and fetal death. • Ultrasound markers can often but not always predict the severity of congenital infection. • A meticulous anatomy survey in mid-trimester remains the norm. • Ultrasound soft markers should prompt comprehensive testing for viral infections in pregnancy.

Intra-Uterine Fetal Demise (IUFD) is defined as death of human conception at age of 20 weeks’ gestation or older or with a minimum 500-g birthweight before complete delivery from the mother and induced termination involved. In 2015, Indonesia has contributed a stillbirth rate of 13 out of 1,000 total births in which 17.1% of the cases were caused by congenital anomalies. Fetal Hydrops as a pathological condition in which there is an accumulation of fluid in fetal soft tissues and serous cavities. With the advancements of sonographic technology, identification of fetal hydrops has become uncomplicated. However, what remains a challenge is to investigate etiology and determine management. In order to plan proper management, the etiology of fetal hydrops must first be determined to predict the prognosis of fetal hydrops. In Indonesia; limited facilities and experts combined with high costs in etiology determination and management have complicated the matter. Furthermore, the strong influence of several Eastern communities’ norms and religious views have further complicated both physicians and patients in decision making. In this report, we present a case of late intra-uterine fetal demise with fetal hydrops, whom was admitted on her 35 weeks age gestation. We performed elective Caesarean Section in order to deliver the stillborn fetus, with no significant post-operative complication. Unfortunately, this condition was actually diagnosed earlier during 20th weeks of gestation, hence advised to continue the pregnancy without further evaluation and information to the mother regarding the hydrops condition.

Background: Sacrococcygeal teratomas (SCT) are often highly vascularized and may result in high-output cardiac failure, polyhydramnios, fetal hydrops, and demise. Delivery is guided by the SCT to fetus volume ratio (SCTratio), SCT growth rate, and cardiac output indexed for weight (CCOi). Methods: We compared measurements and outcome in 12 consecutive fetuses referred with SCT. Adverse outcomes were: fetal surgery, delivery < 32 gestational weeks or neonatal demise. Only SCTratio and CCOi were used to manage the cases. SCT vascularization index (VI%) was derived from the 3D virtual organ computer-aided analysis (VOCAL) software. The SCTModel (modified from acardiac twins) calculated a hypothetical SCT draining vein size and derived a risk line, using diameters of the superior and inferior vena cava, the azygous and umbilical veins. VI% and a model of systemic and umbilical venous volumes (SCTModel) were tested as indicators for outcome in SCT. Results: Fetuses were monitored from 20.1 to 36.4 gestational weeks and 5/12 had adverse outcomes: 1 had successful open fetal surgery at 23.8 weeks and delivered at term, 4 delivered at < 32 weeks with 3/4 having neonatal demise between 25 and 29 weeks. VI% was significantly higher in cases with adverse outcomes (mean 10.3 [8.9–11.6] vs. 4.4 [3.4–5.3], p < 0.0001). The additional fraction of the fetal cardiac output required to perfuse the SCT-draining vein (XSCO%) (p = 0.46), SCTratio (p = 0.08), and CCOi (p = 0.64) were not significant. All cases with adverse outcome had VI% > 8%. The SCTModel risk line predicted nonadverse outcomes well but lacked data in 2/5 cases with adverse outcomes. Conclusions: VI% is a significant indicator of SCT cases with adverse outcomes and combined with SCTratio may guide timing of delivery better than current measures.

PurposeFetal hydrops arises from multiple disease processes and can portend a grim prognosis. We reviewed our experience with hydropic fetuses to understand relevant antenatal anatomic and physiologic predictors of survival.MethodsWe reviewed fetal ultrasounds and echocardiograms of hydropic fetuses evaluated from 1996 to 2013.ResultsOverall neonatal survival in 167 fetuses was 44% (range, 0-75%) and was influenced by the underlying disease process. The anatomic distribution of fluid varied and was not significantly different between survivors and nonsurvivors. Univariate analysis indicated that resolution of hydrops and delivery at a later gestational age were predictive of survival (OR: 5.7 (95% CI: 2.5-13.2) and OR: 1.3 (95% CI: 1.1-1.4), respectively). Fetal intervention also improved survival in some diseases. Echocardiograms were reviewed to group fetuses with similar cardiac physiology and defined categories with high or low/normal cardiothoracic ratio (CTR). Among patients with a high CTR, the cardiovascular profile score was predictive of survival (p=0.009).ConclusionSurvival in hydrops depends on the underlying disease, available fetal therapies to resolve hydrops, and the gestational age of delivery and not on the specific anatomic manifestations of hydrops. In hydropic fetuses with high CTRs, the cardiovascular profile score may be a useful prognostic indicator.

α-Thalassemia (α-thal) is common in southern China. Homozygosity for the - -(SEA) (Southeast Asian) α-globin gene deletion is the most common cause of the Hb Bart's (γ4) disease. Occasionally, other α(0)-thal deletions can also be found. In this study, we report a case with an atypical form of Hb Bart's disease. The fetus was a compound heterozygote for the - -(SEA) and - -(THAI) deletions and presented different clinical features from that of traditional Hb Bart's disease with the - -(SEA) deletion in the homozygous state. The early onset of fetal hydrops is attributed to the decreased formation of embryonic Hb Portland (ζ2γ2), which is proposed as a candidate for reactivation in cases of severe α-thal. Our finding may have potentially important implications for clinical decisions in a program using ultrasonography to identify signs of homozygous α(0)-thal.

The causes and outcomes of fetal hydrops have been well described in the literature over many years. Anti-D immunoglobulin has dramatically reduced the rate (and mortality) of immune hydrops such that non-immune hydrops (NIHF) now accounts for 90% of cases.1 Hydrops is a challenging condition to counsel for due to the relative rarity (1 in 1700–3000 pregnancies) and the fact it is the preterminal manifestation of many different pathophysiological processes.2–4 The paper published in our sister journal Fetal & Neonatal by Gilby et al 5 addresses two key questions that all expectant parents faced with this problem would ask: what is the cause of the hydrops and will my baby survive? Diagnosis in NIHF is of paramount importance to accurate counselling. The more refined the phenotype the more accurate information a clinician is able to provide on mortality, morbidity and treatment options.6 Gilby et al report that with ‘modern’ antenatal investigations, a diagnosis was achieved in 69% of cases while for those without a diagnosis but born alive, 43% were given a postnatal diagnosis. This confirms other recent …

Mirror syndrome, also called Ballantyne syndrome, is a rare condition in pregnancy, defined by the presence of the clinical triad of fetal hydrops, placentomegaly and maternal oedema. Any aetiology of fetal hydrops, including rhesus iso-immunization, congenital infection, twin-to-twin transfusion, structural anomalies and fetal malignancies, can lead to the syndrome. The pathogenesis, although not well established, mimics trophoblastic damage and maternal vascular endothelial dysfunction, as is also seen in pre-eclampsia, and, hence, the two conditions may have a similar clinical presentation. They may even co-exist, where a patient with maternal mirror syndrome develops features of pre-eclampsia. A timely, accurate diagnosis and prompt interventions are needed to prevent fetal mortality and maternal morbidity., Highlights • Mirror syndrome is a rare condition in pregnancy defined by the clinical triad of fetal, placental and maternal hydrops • The correction of fetal hydrops (and, hence placental hydrops) resolves Mirror syndrome • The trophoblastic damage caused by placental oedema causes endothelial dysfunction leading to Mirror syndrome • Although Mirror syndrome and pre-eclampsia have different aetiologies they may have similar presentations and co-exist

Objectives To evaluate and compare perinatal outcome after intrauterine transfusions (IUT) performed before and after 20 weeks of gestation. To analyse contributing factors. Design Retrospective analysis. Setting The Dutch referral centre for fetal therapy. Population IUTs for fetal alloimmune anaemia. Methods Fetuses were divided into two groups: fetuses requiring the first IUT before 20 weeks of gestation (Group 1) and those in which the IUTs started after 20 weeks (Group 2). The cause of perinatal loss was classified as procedure-related (PR) or not procedure-related (NPR). The cohort was divided into two periods to describe the change of perinatal loss over time. Main outcome measures Perinatal loss of fetuses requiring the first IUT before 20 weeks of gestation, compared with perinatal loss later in gestation. Results A total of 1422 IUTs were performed in 491 fetuses. Perinatal loss rate in Group 1 was higher (7/29 24% versus 35/462 8%, P = 0.002). Especially NPR was higher for IUTs performed before 20 weeks (4/37 11% versus 19/1385 1%, P

We tried to identify the influence on the fetus infected with parvovirus B19 (PB19) and retrospectively analyze the severity of fetal infection.Twenty pregnant women who developed maternal PB19 infection were included in this study. A total of 20 amniotic fluid samples were collected for measurement of PB19-DNA, erythropoietin (Epo) and troponin-T (TnT).Of the 5 fetuses with hydrops, 2 were rescued by fetal therapy. Significant differences between groups were found for Epo and TnT: Epo 107.1 ± 45.3 mU/ml and TnT 0.040 ± 0.028 ng/ml (mean ± standard deviation) for the symptomatic fetus group; and Epo 18.9 ± 13.7 mU/ml and TnT 0.008 ± 0.014 ng/ml for the asymptomatic fetus group (p = 0.043 for both variables). Setting Epo ≥50 mU/ml as the predictor of disease onset resulted in an Odds ratio of 56.0, with a 95 % confidence interval of 7.68-1,108.76.The study has determined an amniotic Epo level of ≥50 mU/ml as a factor of the influence on the fetus infected with PB19. The measurement of amniotic Epo level combined with amniotic TnT level is effective for determining the severity of fetal hypoxia.

Congenital extra-adrenal neuroblastoma is a rare condition, which typically has a favorable prognosis. We present a unique case of extra-adrenal retroperitoneal neuroblastoma diagnosed by fetal magnetic resonance imaging, which ultimately leads to fetal hydrops and neonatal death.

Congenital complete atrioventricular block is a known lethal condition. Although antenatal diagnosis and the technical advances of pacemaker treatment have reduced its mortality, treatment of premature babies with significant myocardial damage remains a challenge. In this paper, we report the case of a premature low-birth-weight infant with congenital complete atrioventricular block and extremely low ventricular rate, fetal hydrops, and myocarditis who was successfully treated with staged permanent pacemaker implantation.

A rare case of a low incidence red cell antigen causing severe fetal allo-immune red cell disease is presented. Discussion of how this can be diagnosed and successfully managed antenatally using middle cerebral artery Doppler ultrasound and maternal antibody titre levels for fetal surveillance and timing of intervention with intrauterine transfusion.

The anomalies of the umbilical vessels are uncommon, with the exception of a single umbilical artery. We report a term female infant with fetal hydrops, hypertrophic cardiomyopathy, and a four-vessel umbilical cord consisting of two umbilical arteries and two umbilical veins. The presence of two veins in the umbilical cord has been attributed to persistence of both the normal left umbilical vein and the caudal part of the right umbilical vein. This fetal vascular pathology has been reported very rarely and may be associated with increased risk of congenital malformations and adverse perinatal outcome.

The pericentric inversions are estimated to occur in frequency of 0.12-0.7%, and most commonly discovered in chromosome 1, 9, 16 and Y 1) . Pericentric inversions are usually benign and do not cause any phenotypic effects. However, those inversions can cause an abnormal pregnancy or abnormal offspring by production of recombinant unbalanced gametes 1-8) . The present report describes a case of pericentric inversion 22 in a female experiencing repetitive pregnancy loss and fetal hydrops, which may have been caused by unbalanced recombinant derived from maternal inv(22)(p13q22).

Although cardiac tumours are rare, such tumours are increasingly being diagnosed with increasing frequency and great accuracy by antenatal ultrasound. Cardiac haemangiomas account for less than one-twentieth of all primary cardiac tumours, with most being diagnosed in the neonatal period. We report 3 instances of successful neonatal resection of cardiac haemangioma subsequent to prenatal diagnosis. Such diagnosis is important in perinatal management, since early surgical intervention provides a good prognosis.

We present a case of isolated left ventricular noncompaction (LVNC), a severe congenital cardiomyopathy, which presented in the neonatal period as fetal hydrops. To our knowledge, this is the first child with LVNC presenting with hydrops fetalis to survive infancy. Once considered a uniformly fatal and extremely rare form of cardiomyopathy, LVNC has recently been shown to be more common than previously reported, with a varying range of clinical severity. Although long-term morbidity and mortality are not clearly known, recent work suggests better survivability than once reported.

Intrauterine closure of the fetal ductus arteriosus is a rare but serious condition. It can lead to congestive heart failure, fetal hydrops, and fetal death. No intrauterine intervention is currently available to treat this condition. Postnatally, it can present as pulmonary hypertension and can be associated with high mortality and morbidity. Postnatal therapies aimed at pulmonary hypertension or with medications that maintain the patency of the ductus arteriosus are variably successful. We present the neonatal course of a full-term neonate with severe pulmonary hypertension and intrauterine closure of the ductus arteriosus who survived to early infancy.

Fetal congenital cystic adenomatoid malformation (CCAM) is a rare lung abnormality with a highly variable prognosis depended on the presence of fetal hydrops and the size of the cysts. In case of fetal hydrops the prognosis is fatal without intervention.Case report and literature review.We report on the ultrasound and pathological findings of a hydropic fetus due to a CCAM Type II at 22 weeks of gestation.Congenital cystic adenomatoid malformation is a rare fetal lung disease with an excellent prognosis in the absence of fetal hydrops. CCAM associated with fetal hydrops carries a grave prognosis but survival rates of 70% can be achieved by thoraco-amniotic drainage in those with macrocystic lesions.

Introduction: The Ballantyne syndrome (or mirror syndrome) is a gestational proteinuric hypertension associated with fetal hydrops. This report describes a case in which Ballantyne syndrome reversion occurred despite fetal hydrops persistence. Case Report: A 24-year-old woman showed fetoplacental hydrops at 28 2/7 gestational weeks. Severe Rh(D) alloimmunization and fetal hemolytic anemia (fetal hematocrit 15.4%) were confirmed by cordocentesis, and an intrauterine transfusion was performed. She also revealed hypertension (160/100 mm Hg), edema and proteinuria (845 mg/day). After four intrauterine transfusions, blood pressure was normalized; urinary proteinuria was not significant, and the edema vanished completely. Fetal hydrops persisted until delivery at 32 gestational weeks, but a partial reduction of placental hydrops was noted. Discussion: Total or partial reduction of the placental edema may be responsible for the reversal of the Ballantyne syndrome despite the fetal hydrops persistence.

Erythrovirus (previously parvovirus) B19 was discovered accidentally in 1975 while screening for hepatitis B surface antigen (Chan et al, 1998). It is a small ssDNA virus that targets erythroid progenitor cells. Infection with B19 virus during pregnancy may cause serious complications in the fetus such as fetal hydrops and intrauterine fetal death. Early diagnosis and treatment is essential in the management of these complications. We conducted a survey study to assess the awareness of both front and second-line obstetric staff(GPs, midwives, senior house officers, specialist registrars and consultants) of B19 as a potential and treatable cause of hydrops fetalis. Overall there was poor awareness particularly among the front-line carers compared to the second-line carers regarding the diagnosis and management of B19 infection in pregnancy. A total of 94% of the responders agreed there was a need for educational updates on the role of B19 infection during pregnancy.