Maternal hepatitis B infection as the cause of nonimmunologic hydrops fetalis

: A 16-year-old primigravida was referred to our department at 22 weeks gestation because of a nonimmune hydrops fetalis. Sonography revealed an isolated fetal ascites. Cordocentesis was performed to rule out anaemia, infection and chromosomale abnormalities, followed subsequently by intrauterine transfusion because of fetal anaemia (hemoglobin-concentration of 8.4 g/dl). It was found that the pregnant suffered from an acute hepatitis-B-virus-infection with positive HBsAg, positive HBeAg and HBc-IgM antibodies, confirmed by serological tests. In a second cordocentesis the cordblood specimen was found to be HBsAg positive as well. The fetus was intramusculary given hyperimmune-globulin under ultrasound guidance. In the further course of pregnancy signs of meconium-peritonitis were observed. Postnatally a distal ileal perforation was detected and the newborn underwent laparotomy for distal ileal perforation. In this case report we discuss the connection with nonimmune hydrops fetalis and the maternal and fetal hepatitis-B-virus-infection.