Abstract：
BACKGROUND: Perinatal Hepatitis C Virus (HCV) transmission occurs in 4-7% of the cases with detectable viremia at delivery. HCV testing in pregnancy is recommended. The fetal infection was previously described as asymptomatic although there are two cases, including this one, to report the presence of isolated fetal ascites in HCV infected fetuses.
METHODS: A 42-year-old patient, 3G, 3P, presented in the Emergency Room for painful uterine contraction. The third-trimester ultrasound examination noted severe fetal ascites, accompanied by hyperechoic bowels and polyhydramnios. The diagnosis required a detailed ultrasound exam, invasive testing (amniocentesis, cordocentesis, and fetal paracentesis), and a complete workup. The mother tested positive for HCV antibodies, and the fetal cord blood tested positive for HCV RNA. The ascites resolved after paracentesis, and the gastrointestinal and respiratory functions markedly improved. The fetus was delivered at term in good condition.
CONCLUSIONS: The etiology of isolated fetal ascites is broad. This case may indicate that intrauterine HCV transmission is a potential cause of isolated fetal ascites in the absence of other explanation, and isolated fetal ascites can be the only sign revealed on a routine examination. We suspected, having no other detected cause for ascites, the intrauterine transmission of HCV. Invasive procedures, such as paracentesis, are required for abdominal decompression to manage isolated fetal ascites, as it may be a saving procedure. A genetic investigation is needed, and a good neonatal outcome is expected in the absence of fetal structural or genetic abnormalities, as in our case.
METHODS: A 42-year-old patient, 3G, 3P, presented in the Emergency Room for painful uterine contraction. The third-trimester ultrasound examination noted severe fetal ascites, accompanied by hyperechoic bowels and polyhydramnios. The diagnosis required a detailed ultrasound exam, invasive testing (amniocentesis, cordocentesis, and fetal paracentesis), and a complete workup. The mother tested positive for HCV antibodies, and the fetal cord blood tested positive for HCV RNA. The ascites resolved after paracentesis, and the gastrointestinal and respiratory functions markedly improved. The fetus was delivered at term in good condition.
CONCLUSIONS: The etiology of isolated fetal ascites is broad. This case may indicate that intrauterine HCV transmission is a potential cause of isolated fetal ascites in the absence of other explanation, and isolated fetal ascites can be the only sign revealed on a routine examination. We suspected, having no other detected cause for ascites, the intrauterine transmission of HCV. Invasive procedures, such as paracentesis, are required for abdominal decompression to manage isolated fetal ascites, as it may be a saving procedure. A genetic investigation is needed, and a good neonatal outcome is expected in the absence of fetal structural or genetic abnormalities, as in our case.
摘要：
背景：在分娩时可检测到病毒血症的病例中，有4-7％发生围产期丙型肝炎病毒（HCV）传播。建议在怀孕期间进行HCV检测。胎儿感染以前被描述为无症状，尽管有2例，包括这个,报告HCV感染胎儿中孤立的胎儿腹水的存在。
方法：一名42岁的患者，3G,3P,出现在急诊室疼痛的子宫收缩。妊娠晚期超声检查发现严重的胎儿腹水，伴有高回声肠和羊水过多。诊断需要详细的超声检查，侵入性测试(羊膜穿刺术，脐带穿刺术,和胎儿穿刺)，和一个完整的工作。母亲的HCV抗体检测呈阳性,胎儿脐带血检测出HCVRNA阳性.腹水在穿刺术后消退，胃肠道和呼吸功能明显改善。胎儿足月分娩状况良好。
结论：孤立性胎儿腹水的病因广泛。这种情况可能表明，在没有其他解释的情况下，宫内HCV传播是孤立的胎儿腹水的潜在原因。孤立的胎儿腹水可能是常规检查中唯一发现的迹象。我们怀疑,没有其他发现腹水的原因，HCV的宫内传播。侵入性程序，比如穿刺术,需要腹部减压来处理孤立的胎儿腹水，因为这可能是一个保存程序。需要进行基因调查,在没有胎儿结构或遗传异常的情况下，预期良好的新生儿结局，就像我们的情况一样。
方法：一名42岁的患者，3G,3P,出现在急诊室疼痛的子宫收缩。妊娠晚期超声检查发现严重的胎儿腹水，伴有高回声肠和羊水过多。诊断需要详细的超声检查，侵入性测试(羊膜穿刺术，脐带穿刺术,和胎儿穿刺)，和一个完整的工作。母亲的HCV抗体检测呈阳性,胎儿脐带血检测出HCVRNA阳性.腹水在穿刺术后消退，胃肠道和呼吸功能明显改善。胎儿足月分娩状况良好。
结论：孤立性胎儿腹水的病因广泛。这种情况可能表明，在没有其他解释的情况下，宫内HCV传播是孤立的胎儿腹水的潜在原因。孤立的胎儿腹水可能是常规检查中唯一发现的迹象。我们怀疑,没有其他发现腹水的原因，HCV的宫内传播。侵入性程序，比如穿刺术,需要腹部减压来处理孤立的胎儿腹水，因为这可能是一个保存程序。需要进行基因调查,在没有胎儿结构或遗传异常的情况下，预期良好的新生儿结局，就像我们的情况一样。
