A 17-week pregnant woman delivers a stillborn baby with a large size, and the placenta is also large. The baby has rashes on the face. What is the most likely cause of these findings?

1. A

   Congenital rubella syndrome

2. B

   Herpes Simplex Virus (HSV)

3. C

   Parvovirus syndrome

4. D

   Congenital syphilis syndrome

Appeared in: NORCET 8 Prelims-2025

Explanation

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• The combination of a large fetus and a large placenta in a mid-trimester stillbirth is the classic presentation of hydrops fetalis.
• Parvovirus B19 is the most common infectious cause of non-immune hydrops fetalis.
• The virus attacks fetal red blood cell precursors, causing severe anemia, which leads to heart failure and massive fluid accumulation (hydrops).
• This cascade of events directly explains the large size of the baby and placenta, and often results in fetal death.

Why Other Options Were Wrong

• Option A: Congenital rubella is classically associated with intrauterine growth restriction (IUGR), leading to a small-for-gestational-age baby, which is the opposite of the findings.
• Option B: Congenital Herpes Simplex Virus (HSV) infection does not typically cause a large baby or placenta. It's primarily associated with skin vesicles, eye problems, and central nervous system disease.
• Option D: While congenital syphilis can cause stillbirth, placentomegaly, and hydrops, Parvovirus B19 is a more common and classic cause for this specific presentation of severe mid-trimester hydrops fetalis.

Related Visual

• Visual 1: Ultrasound image showing hydrops fetalis: An image depicting fetal ascites (fluid in the abdomen) and skin edema to help visualize the 'large baby' appearance.
• Visual 2: Infographic of TORCH infections: A chart comparing the typical findings of Toxoplasmosis, Other (Syphilis, Parvovirus), Rubella, CMV, and HSV to highlight their differing effects on the fetus.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Differential diagnosis of congenital infections based on fetal and placental findings as background academic context rather than a clinical decision trigger.
• Recognizing the signs of hydrops fetalis (large fetus, large placenta, polyhydramnios) on ultrasound is critical for prompting an investigation into the underlying cause, including infectious etiologies.
• Screening for TORCH infections is a key part of antenatal care. A nurse plays a vital role in educating expectant mothers about prevention, recognizing signs of infection, and ensuring appropriate screening is done.
• What if the question stated the baby was small for its gestational age with cataracts? The answer would shift to Congenital Rubella Syndrome, as IUGR and cataracts are hallmark features of that condition.

How to Approach the Question

• First, identify the key clinical findings presented in the stem: a 17-week stillbirth, a large baby, a large placenta, and a facial rash.
• Recognize that the combination of a 'large baby' and 'large placenta' strongly points to the diagnosis of hydrops fetalis.
• Systematically evaluate each option's known effects on a fetus. Ask yourself: 'Which of these infections is known to cause hydrops fetalis?'
• Eliminate options that cause opposite or unrelated findings. For example, Rubella causes a small baby (IUGR), so it can be ruled out.
• Compare the remaining plausible options. Both Parvovirus and Syphilis can cause hydrops, but Parvovirus is the most classic and common infectious cause for this specific presentation.
• Select the option that provides the most direct and common explanation for the dominant clinical feature, which is hydrops fetalis.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of congenital infections based on fetal and placental findings.
• Stem keywords: 17-week pregnant, stillborn baby, large size, large placenta, rashes on face
• Lead-in keywords: most likely cause
• Clinical cues: Large baby and large placenta: This combination strongly suggests hydrops fetalis, a critical clue pointing towards specific underlying causes like Parvovirus B19.

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