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Introduction. Vertical transmission of hepatitis C virus (HCV) occurs in rare cases (5-8%), more often during birth and, seldom, transplacental, before birth. Hepatitis C virus can cause acute or chronic hepatitis. Materials and method. We present the case of a 42-year-old woman, gravida 2, para 2, with 32 weeks of gestation. The ultrasound exam noticed fetal ascites, polyhydramnios and echogenic fetal bowel. The mother was tested for the TORCH panel, including HCV. Anti-HCV antibodies were present. We decided to perform fetal cordocentesis, paracentesis and amniocentesis. From cordocentesis we obtained approximately 8 ml of fetal blood, analyzed for: albumin, direct bilirubin, indirect bilirubin, total bilirubin, blood count, blood glucose, direct Coombs test, HCV RNA, IgM antibodies for cytomegalovirus/toxoplasmosis/Rubella/herpes simplex type 1 and 2. Also, 160 ml of fetal ascites fluid were sent for cytological and biochemical analysis, and 40 ml of clear amniotic fluid were used to detect infection with herpes simplex, Epstein-Barr or parvovirus. Results. The biochemical tests and blood count performed from the fetal blood were within normal range. The direct Coombs test was negative. HCV RNA was detected. Antibodies for cytomegalovirus/toxoplasmosis/Rubella/herpes simplex type 1 and 2, Epstein-Barr and parvovirus B19 were absent. The biochemical tests performed from the fetal ascites fluid showed: red blood cells 3000/mm³, leukocytes 835/mm³, glucose 57 mg/dL, albumin 1.90 g/dL, creatinine 0.53 mg/dL, urea 19 mg/dL, proteins 3.4 g/dL, positive Rivalta test. HCV RNA was detected. IgM antibodies for cytomegalovirus/toxoplasmosis/Rubella/herpes simplex type 1 and 2 were all absent. Fetal ascites markedly decreased and normal echogenicity of the bowel was noted. Conclusions. In rare cases, HCV can be transmitted vertically from the mother to the unborn baby. Cordocentesis and paracentesis helped us diagnose the fetus before birth and improve his prognosis after birth. [ABSTRACT FROM AUTHOR]

Introduction. Hepatitis C virus (HCV) can cause acute or chronic hepatitis. HCV can be spread through inadequate sterilization or reuse of syringes and needles, blood transfusion, injecting drug use, sexual intercourse, and vertical transmission from the mother to the fetus, although the last two are very rare. Vertical transmission of HCV occurs in rare cases (5-8%), more often during birth, and seldom transplacental, before birth. Women infected with HCV are more predisposed to give birth to preterm babies or low birth weight babies, or babies with congenital anomalies. Materials and method. We present the case of a 42-year-old woman, gravida 2, para 2, with a 32-33-week pregnancy, with not investigated deaf-mutism, who came in the emergency room for preterm labor contractions. At the ultrasound exam, we noticed fetal ascites, polyhydramnios and echogenic fetal bowel. The patient was admitted to our clinic for further investigations. We recommended an amniocentesis and a genetic consultation. The mother was tested for the TORCH panel, including HCV. The anti-HCV antibodies were present. In our service, the mother was also diagnosed with gestational diabetes. Following the clinical and paraclinical investigations performed, we decided to perform fetal cordocentesis, paracentesis and amniocentesis. Under ultrasound guidance, we performed cordocentesis and obtained approximately 8 ml of fetal blood and sent it for the following biological tests: albumin, direct bilirubin, indirect bilirubin, total bilirubin, blood count, blood glucose, direct Coombs test, HCV RNA, IgM antibodies for cytomegalovirus/ toxoplasmosis/rubella/herpes simplex type 1 and 2. For the second puncture, the catheter was introduced at the level of the fetal peritoneal cavities under ultrasound guidance. We extracted 160 ml of fetal ascites fluid and sent it for cytological and biochemical analysis (leukocytes, red blood cells, glucose, albumin, creatinine, urea, proteins, Rivalta test, cytological examination). We also performed amniocentesis and collected 40 ml of clear amniotic fluid. We used it to detect an infection with herpes simplex virus, Epstein-Barr virus, or parvovirus. Results. The biochemical tests and blood count performed from the fetal blood were within normal range. The direct Coombs test was negative. HCV RNA was detected (251 UI/mL). IgM antibodies for cytomegalovirus/ toxoplasmosis/rubella/herpes simplex type 1 and 2 were all absent, and antibodies for Epstein-Barr virus and parvovirus B19 were also absent. The cytological exam of the ascites fluid showed smears with hypercellularity: very frequently lymphocytes, rare isolated mesothelial cells within normal cytological limits, rare polymorphonuclear leukocytes, and rare red blood cells. The biochemical tests performed from the fetal ascites fluid showed: red blood cells (3000/mm3), leukocytes 835/mm3, glucose 57 mg/dL, albumin 1.90 g/dL, creatinine 0.53 mg/dL, urea 19 mg/dL, proteins 3.4 g/dL, positive Rivalta test. HCV RNA was detected. IgM antibodies for cytomegalovirus/toxoplasmosis/rubella/ herpes simplex type 1 and 2 were all absent. After fetal diagnosis, our colleagues from the infectious disease department recommended parenteral/oral hepatoprotective treatment for the mother; there was no possibility of antiviral treatment of the fetus. After performing the paracentesis of the fetus, the amniotic fluid was in the normal range, the fetal ascites were in small quantity with ultrasonographic hepatosplenomegaly aspect and normal echogenicity of the bowel. Almost seven weeks after the paracentesis, the patient gave birth to a baby, gender male, weight 2880 g, with an Apgar score of 7, which was handed over to the neonatology service, for further investigations. Conclusions. In rare cases, HCV can be transmitted vertically from the mother to the unborn baby. Cordocentesis and paracentesis helped us diagnose the fetus before birth and improve his prognosis after birth. [ABSTRACT FROM AUTHOR]