Clinical Pearls

Parvovirus infection in pregnancy can cause fetal anemia leading to hydrops fetalis.

Hydramnios is one of the earliest manifestations of fetal hydrops.

Parvovirus infection in the adult commonly leads to subtle findings of myalgias, malaise, and the reticular rash, whereas an infected child often has a high fever and a "slapped cheek" appearance.

Some causes of hydramnios include gestational diabetes, isoimmunization, syphilis, fetal cardiac arrhythmias, and fetal intestinal atresias.

REFERENCES

Cunningham FG, Leveno KJ. Bloom SL. Hauih JC, Gilstrap LC III. Wcnstrom KD. Abnormalities of the fetal membranes and amniotic fluid. In: Williams obstetrics, 22nd ed. New York: McGraw-Hill, 2005:817-821.

Gambone JC, Moore JG. Koos BJ. Common medical and surgical conditions complicating pregnancy. In: Hacker NF, Moore JG, Gambone JC, eds. Essentials of obstetrics and gynecology. 4th ed. Philadelphia: Saunders, 2004:216-246.

A 22-year-old nulliparous woman presents to the physician's office with a 4- to 5-day history of fever, malaise, and sores on her vulva. She experiences discomfort, especially when she is sitting. She denies a history of prior episodes of vulvar sores or ulcers. She recalls that her last episode of sexual intercourse was 10 days ago. On examination, her blood pressure is 120/78, heart rate 80 bpm. and she is afebrile. Heart and lung examinations are normal. Inspection of the vulva region reveals multiple, shallow vulvar ulcers 5 to 10 mm in diameter on the labia majora and minora. The inguinal lymph nodes are enlarged bilaterally and nontender.

♦ What is your next diagnostic step?

♦ What is the most likely diagnosis?

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