Fetal meconium peritonitis after maternal hepatitis B: a case report and review of the literature.

Maternal hepatitis virus has rarely been implicated in fetal meconium peritonitis (FMP), and its underlying mechanism is largely unknown. We describe a case of FMP presumably caused by maternal chronic hepatitis B virus (HBV). A 29-year-old primigravid woman was referred to our hospital at 35 weeks of gestation for the disappearance of fetal movements. The maternal prenatal history included HBV for more than 10 years. Her HBV DNA level was suppressed (<20 IU/mL) and she was taking oral tenofovir disoproxil fumarate (300 mg/day). At 21+5 weeks, fetal ascites, echogenic bowel, and intra-abdominal calcifications were observed by abdominal ultrasound. These findings were confirmed by magnetic resonance imaging and were regarded as diagnostic for FMP. Cord blood and amniotic fluid were positive for hepatitis B e antigen and hepatitis B surface antigen. Ascites of the FMP was completely self-absorbed at 27+3 weeks. At 35 weeks of gestation, fetal movements had vanished and male stillbirth was induced. A histopathological examination of the placenta showed meconium uptake by macrophages in the amniochorionic membranes. Our findings suggest that maternal HBV can cross the placenta and induce FMP. Close surveillance may allow an early diagnosis of FMP and prevent fetal mortality.