Parvovirus

Infective organism

• Parvovirus B19 (PVB19) is a relatively common

infection in pregnancy, and is transmitted through
respiratory droplets.
Incidence
• Immunity to PVB19 infection occurs in 50% of women of
childbearing age and therefore 50% are susceptible to infection
during pregnancy.
• It occurs most commonly in those pregnant women who work
with young children, for example teachers.
• Routine screening in pregnancy is not currently recommended as
there are currently no agreed treatment or prevention methods to
protect the baby from being infected.
Clinical features
• In adults, many (20–25%) cases are asymptomatic or produce
symptoms of a mild flu-like illness and/or arthropathy.
• In children it usually causes a characteristic rash (slapped cheek
syndrome).
• There is a transplacental transmission rate of 17–33% and the
fetus is most vulnerable if infected in the second trimester.
Clinical features
• In most fetuses infected with PVB19, there will be spontaneous
resolution with no long-term consequences, but the infection can cause an
aplastic anaemia.
• The anaemic fetus may then become hydropic due to high output cardiac
failure and liver congestion. This is the most common presentation during
pregnancy and is seen on ultrasound scan. If a fetus is hydropic, the
velocity of blood flow in the fetal middle cerebral artery can be measured.
If the velocity is high, it is suggestive of anaemia, and PVB19 would be
one of several differential diagnoses.
Management
• The diagnosis is made by demonstrating seroconversion of the mother,
who develops IgM antibodies to PVB19, having previously tested
negative.
• Viral DNA amplifications, using PCR in maternal and fetal serum or
amniotic fluid, is the most sensitive and accurate diagnostic test.
• A hydropic fetus may recover spontaneously as the mother and fetus
recover from the virus, or may require treatment by in utero transfusion.
Management
• Infection in the first 20 weeks of pregnancy can lead to hydrops fetalis and
intrauterine death, as treatment by intrauterine transfusion is not possible at
early gestations. Prior to 20 weeks the fetal loss rate is approximately 10%.
• If the anaemia is treated by in utero transfusion, the fetus can make a complete
recovery.
• Parvovirus does not cause neurological damage, and if the fetus survives the
anaemia, the outcome is usually normal.
• After 20 weeks’ gestation the fetal loss rate is estimated to be approximately 1%.
Reference
• OBSTETRICS | 20th EDITION by Ten Teachers