Intrauterine transmission of hepatitis A virus

Background: Hepatitis A is a common, self-limited disease transmitted by fecal-oral contamination. Case: A 23-year-old woman, para 2-0-0-2, developed hepatitis A at 20 weeks' gestation. At 27 weeks, ultrasound revealed polyhydramnios and fetal ascites. Hepatitis A immunoglobulin M antibody in fetal blood obtained by funipuncture confirmed acute hepatitis A infection in the fetus. Polyhydramnios and ascites persisted until 35 weeks, when the fetus developed ultrasound signs of meconium peritonitis, and delivery was accomplished uneventfully. Meconium peritonitis was diagnosed in the neonatal period and treated surgically. Conclusion: To our knowledge, this is the first report of intrauterine transmission of hepatitis A. The disease presented with fetal ascites and was confirmed by positive fetal blood serology.