Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients Caregivers Providers
Log In Ask a Question
PubMed This is a summary of 22 peer-reviewed journal articles Updated
Obstetrics and Gynecology

Can Maternal Viral Infections Cause Hydrops Fetalis?

At a Glance

Yes, maternal infections like Parvovirus B19, Syphilis, CMV, and Toxoplasmosis can cause non-immune hydrops fetalis. These infections cross the placenta, sometimes causing severe fetal anemia. Diagnosis involves maternal blood tests and amniocentesis, and treatments like in-utero transfusions or antibiotics are often available.

In this answer

3 sections

01

Common Infectious Causes

02

How Infectious Causes Are Diagnosed

03

Treatment and Management

Yes, certain viral or parasitic infections contracted during pregnancy can cause non-immune hydrops fetalis (NIHF), though they are not the most common causes [1][2][3]. When a pregnant person catches a common virus, it can sometimes cross the placenta and affect the developing baby. It is completely normal to wonder if something you did or caught caused this condition. If an infectious cause is found, it simply explains the how—it is not your fault. Exposure to everyday viruses is largely out of anyone’s control.

Common Infectious Causes

The most common infections associated with NIHF are grouped in what doctors refer to as TORCH infections. This stands for Toxoplasmosis, Other (which includes Syphilis, Parvovirus B19, and Varicella), Rubella, Cytomegalovirus, and Herpes.

The most prominent infectious triggers include:

  • Parvovirus B19 (Fifth Disease): This is the infectious pathogen most strongly linked to fetal hydrops [4][5]. The virus targets and destroys the baby’s developing red blood cells, leading to severe fetal anemia [4][6]. To compensate for the lack of red blood cells, the baby’s heart has to pump much harder, which can eventually lead to high-output cardiac failure and fluid accumulation [4][6].
  • Syphilis: A bacterial infection that is experiencing a global resurgence, syphilis can pass to the baby and cause hydrops, but it is highly treatable with maternal antibiotics if caught early.
  • Cytomegalovirus (CMV): CMV is a very common virus that usually causes mild or no symptoms in adults but can affect fetal heart function and lead to hydrops [7][8].
  • Toxoplasmosis: Caused by a parasite (often found in undercooked meat, unwashed produce, or cat feces), toxoplasmosis can also lead to changes in fetal heart function and fluid buildup [4][7].

How Infectious Causes Are Diagnosed

Discovering if an infection caused the hydrops usually involves a two-step process:

  1. Maternal Blood Work (Screening): Your doctor will likely start by checking your TORCH titers [5][9]. These are blood tests that measure the level of specific antibodies in your immune system. If your blood shows recent antibodies (IgM), it suggests you were recently exposed. However, this only proves you were exposed—not that the infection reached the baby.
  2. Amniocentesis (Confirmation): To definitively diagnose an infection in the baby, doctors typically recommend an amniocentesis [10][11]. This involves using a fine needle to take a small sample of the amniotic fluid surrounding the baby. The fluid is then tested for the actual DNA of the virus or parasite using a highly accurate technique called PCR [10][11].

While doctors may start with infectious screening, the diagnostic workup for NIHF today also heavily relies on advanced genetic testing (like exome sequencing or chromosomal microarrays) because genetic and structural issues are actually the most common causes of hydrops [12][13][14].

Treatment and Management

Finding out that an infection caused the hydrops can be overwhelming. While NIHF is always a highly serious condition requiring intensive monitoring, some infectious causes have targeted treatments.

  • Treating Parvovirus B19: If your doctor suspects Parvovirus B19, they will perform specialized, non-invasive belly ultrasound scans—specifically looking at the blood flow in the baby’s brain (Middle Cerebral Artery Doppler)—to check for fetal anemia [15][16]. If severe anemia is found, maternal-fetal medicine specialists can perform an in-utero transfusion (IUT). This procedure delivers a blood transfusion directly to the baby while they are still in the womb [15][17]. It is a highly effective, life-saving intervention for severe anemia that can resolve the hydrops and significantly improve the baby’s chances of survival [15][18][19]. However, IUT is an invasive procedure that involves placing a needle into the womb, which carries risks such as fetal distress, fetal bradycardia (slow heart rate), or premature labor, which your doctor will carefully discuss with you [20][21][22].
  • Treating Other Infections: Depending on the specific pathogen, other medical treatments may be available. For example, Syphilis is treated with a course of penicillin given to the mother, which crosses the placenta to treat the baby. In cases of Toxoplasmosis, maternal antiparasitic medications can be prescribed, and emerging antiviral therapies may sometimes be discussed for certain CMV cases.

Common questions in this guide

How do doctors test if an infection caused hydrops fetalis?
Doctors typically start with a maternal blood test to check for TORCH antibodies, indicating recent exposure. If positive, they may recommend an amniocentesis to test the amniotic fluid for the actual virus using an accurate DNA test.
What is the most common virus that causes non-immune hydrops fetalis?
Parvovirus B19, also known as Fifth Disease, is the infectious pathogen most strongly linked to fetal hydrops. It targets the developing baby's red blood cells, which can cause severe fetal anemia and heart failure.
Can hydrops fetalis caused by a viral infection be treated?
Yes, some infectious causes have targeted treatments. Severe fetal anemia caused by Parvovirus B19 can be treated with an in-utero blood transfusion, while bacterial infections like syphilis are treated with maternal antibiotics.
Is it my fault if my baby develops hydrops from an infection?
No, it is not your fault. Exposure to everyday viruses like CMV and Parvovirus B19 is largely out of anyone's control, and catching a common virus during pregnancy does not mean you did anything wrong.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Which specific infections were tested for in my maternal blood work, and did the TORCH titers indicate any recent exposures?
  2. 2.If my blood work shows a recent infection, do you recommend an amniocentesis to confirm if the virus has crossed the placenta?
  3. 3.Are you seeing signs of severe fetal anemia on the ultrasound, specifically when looking at the Middle Cerebral Artery (MCA) Doppler?
  4. 4.If an in-utero transfusion is needed, is that performed at this hospital, or will I be transferred to a specialized fetal center with more experience?
  5. 5.What are the specific risks to me and the baby if we proceed with an invasive procedure like an amniocentesis or in-utero transfusion?
  6. 6.If the hydrops is caused by an infection like Syphilis or Toxoplasmosis, what maternal medications (like antibiotics) can be started immediately?
  7. 7.If my infectious blood work is negative, what genetic or structural tests are we pursuing next?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

Can Non-Immune Hydrops Fetalis Resolve on Its Own?Does Non-Immune Hydrops Fetalis Cause Premature Birth?How Are Fetal Arrhythmias Causing Hydrops Treated?How Are Intrauterine Blood Transfusions for Hydrops Done?What Are Long-Term Outcomes for NIHF Survivors?What Are the Symptoms of Mirror Syndrome vs Normal Swelling?What Does Idiopathic Non-Immune Hydrops Fetalis Mean?What Is a Thoracoamniotic Shunt for Fetal Hydrops?Immune vs. Non-Immune Hydrops: What Is the Difference?Will Non-Immune Hydrops Fetalis Happen Again?Why Do I Need Perinatal Palliative Care for NIHF?What to Expect Delivering a Baby With Hydrops Fetalis?Why Do I Need an Amniocentesis for Hydrops Fetalis?Why Use Whole Exome Sequencing for Hydrops Fetalis?

References

References (22)
  1. 1

    Hereditary Anemias as a Monogenic Etiology for Nonimmune Hydrops Fetalis.

    Makhamreh MM, Rice SM, Shivashankar K, et al.

    Clinical therapeutics 2026; doi:10.1016/j.clinthera.2026.01.002.

    PMID: 41638966
  2. 2

    Association between mucopolysaccharidosis Type VII and hydrops fetalis.

    Holtz M, Montaño AM, Sly WS

    Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2020; (55(3)):416-417 doi:10.1002/uog.20371.

    PMID: 31180609
  3. 3

    A systematic review of monogenic etiologies of nonimmune hydrops fetalis.

    Quinn AM, Valcarcel BN, Makhamreh MM, et al.

    Genetics in medicine : official journal of the American College of Medical Genetics 2021; (23(1)):3-12 doi:10.1038/s41436-020-00967-0.

    PMID: 33082562
  4. 4

    Confirmation of etiology in fetal hydrops by sonographic evaluation of fluid allocation patterns.

    Hartge DR, Weichert J, Gembicki M, Krapp M

    European journal of obstetrics, gynecology, and reproductive biology 2015; (195()):128-132 doi:10.1016/j.ejogrb.2015.09.006.

    PMID: 26540593
  5. 5

    Dual pathology of parvovirus B19 infection and Aicardi-Goutières syndrome complicating non-immune hydrops fetalis.

    Shekhawat DS, Das S, Sharma C, et al.

    BMJ case reports 2025; (18(7)) doi:10.1136/bcr-2025-266781.

    PMID: 40744631
  6. 6

    Parvovirus B19 infection during pregnancy and risks to the fetus.

    Ornoy A, Ergaz Z

    Birth defects research 2017; (109(5)):311-323 doi:10.1002/bdra.23588.

    PMID: 28398685
  7. 7

    Non-immune hydrops fetalis: A retrospective analysis of 151 autopsies performed at a single center.

    Kaykı G, Güçer Ş, Akçören Z, et al.

    The Turkish journal of pediatrics 2018; (60(5)):471-477.

    PMID: 30968631
  8. 8

    Nonimmune Hydrops Fetalis.

    Dunn SB, Whittington JR

    NeoReviews 2024; (25(8)):e475-e485 doi:10.1542/neo.25-8-e475.

    PMID: 39085173
  9. 9

    No. 363-Investigation and Management of Non-immune Fetal Hydrops.

    Désilets V, De Bie I, Audibert F

    Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2018; (40(8)):1077-1090 doi:10.1016/j.jogc.2017.12.011.

    PMID: 30103882
  10. 10

    Amniocentesis to diagnose congenital cytomegalovirus infection following maternal primary infection.

    Dinsmoor MJ, Fette LM, Hughes BL, et al.

    American journal of obstetrics & gynecology MFM 2022; (4(4)):100641 doi:10.1016/j.ajogmf.2022.100641.

    PMID: 35526782
  11. 11

    Management of suspected primary Toxoplasma gondii infection in pregnant women in Norway: twenty years of experience of amniocentesis in a low-prevalence population.

    Findal G, Helbig A, Haugen G, et al.

    BMC pregnancy and childbirth 2017; (17(1)):127 doi:10.1186/s12884-017-1300-1.

    PMID: 28441952
  12. 12

    Diagnostic yield from prenatal exome sequencing for non-immune hydrops fetalis: A systematic review and meta-analysis.

    Al-Kouatly HB, Shivashankar K, Mossayebi MH, et al.

    Clinical genetics 2023; (103(5)):503-512 doi:10.1111/cge.14309.

    PMID: 36757664
  13. 13

    Value of Exome Sequencing in Diagnosis and Management of Recurrent Non-immune Hydrops Fetalis: A Retrospective Analysis.

    Zhou X, Zhou J, Wei X, et al.

    Frontiers in genetics 2021; (12()):616392 doi:10.3389/fgene.2021.616392.

    PMID: 33897756
  14. 14

    An Investigation of the Etiologies of Non-Immune Hydrops Fetalis in the Era of Next-Generation Sequence-A Single Center Experience.

    Wei X, Yang Y, Zhou J, et al.

    Genes 2022; (13(12)) doi:10.3390/genes13122231.

    PMID: 36553497
  15. 15

    Parvovirus B19 Infection and Pregnancy: Review of the Current Knowledge.

    Dittmer FP, Guimarães CM, Peixoto AB, et al.

    Journal of personalized medicine 2024; (14(2)) doi:10.3390/jpm14020139.

    PMID: 38392573
  16. 16

    Fetal anemia: Diagnosis and management.

    Prefumo F, Fichera A, Fratelli N, Sartori E

    Best practice & research. Clinical obstetrics & gynaecology 2019; (58()):2-14 doi:10.1016/j.bpobgyn.2019.01.001.

    PMID: 30718211
  17. 17

    Intrauterine transfusion in 103 fetuses with severe anemia caused by parvovirus infection. A multicenter retrospective study.

    Kosian P, Hellmund A, Geipel A, et al.

    Archives of gynecology and obstetrics 2023; (308(1)):117-125 doi:10.1007/s00404-022-06712-z.

    PMID: 35916962
  18. 18

    Early Intrauterine Transfusion in Fetuses with Severe Anemia Caused by Parvovirus B19 Infection.

    Hellmund A, Geipel A, Berg C, et al.

    Fetal diagnosis and therapy 2018; (43(2)):129-137 doi:10.1159/000477208.

    PMID: 28633140
  19. 19

    Intrauterine transfusion: Best practices, techniques, and evolving trends.

    Devlieger R, Vergote S, Van den Eede E, et al.

    Best practice & research. Clinical obstetrics & gynaecology 2026; (104()):102686 doi:10.1016/j.bpobgyn.2025.102686.

    PMID: 41289715
  20. 20

    Intrauterine Transfusion for Rhesus Alloimmunization: A Historical Retrospective Cohort from A Single Reference Center in Brazil.

    Pares DBDS, Pacheco GHAS, Lobo GAR, Araujo Júnior E

    Journal of clinical medicine 2024; (13(5)) doi:10.3390/jcm13051362.

    PMID: 38592667
  21. 21

    Intrauterine transfusion under fetal analgesia: the evaluation of perinatal outcomes.

    Lanna M, Casati D, Bianchi C, et al.

    Frontiers in pain research (Lausanne, Switzerland) 2024; (5()):1405465 doi:10.3389/fpain.2024.1405465.

    PMID: 39119527
  22. 22

    Complications of intrauterine intravascular blood transfusion: lessons learned after 1678 procedures.

    Zwiers C, Lindenburg ITM, Klumper FJ, et al.

    Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2017; (50(2)):180-186 doi:10.1002/uog.17319.

    PMID: 27706858

This page is for informational purposes only and does not replace professional medical advice. Always consult your maternal-fetal medicine specialist for guidance on pregnancy complications and treatment options.

Get notified when new evidence is published on Non-immune hydrops fetalis.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.