Parvovirus Infection and Parvovirus Infection and PregnancyPregnancy

Max Brinsmead MB BS PhDMax Brinsmead MB BS PhDMay 2015May 2015

ParvovirusParvovirus

Caused by Parvovirus B19 Caused by Parvovirus B19 Causes epidemic Fifth Disease or Causes epidemic Fifth Disease or

“Slapped Cheek Syndrome” in pre school “Slapped Cheek Syndrome” in pre school children.children.

When intrauterine infection occurs it When intrauterine infection occurs it affects haemopoeisis. This results in fetal affects haemopoeisis. This results in fetal anaemia and hydrops fetalis.anaemia and hydrops fetalis.

However, recovery is usually spontaneous However, recovery is usually spontaneous and complete and there are no long term and complete and there are no long term sequelaesequelae

Vertical Parvovirus TransmissionVertical Parvovirus Transmission 50-66% of pregnant women are Parvovirus 50-66% of pregnant women are Parvovirus

immuneimmune Most infections occur from the mother’s own pre Most infections occur from the mother’s own pre

school childschool child Spread by droplets c sneezing, coughingSpread by droplets c sneezing, coughing Incubation period is 4 -14 daysIncubation period is 4 -14 days Rash occurs on the face but also on hands, Rash occurs on the face but also on hands,

wrists & kneeswrists & knees Maternal symptoms include polyarthalgia, fever Maternal symptoms include polyarthalgia, fever

and non specific rashand non specific rash Risk of maternal infection is increased by Risk of maternal infection is increased by

immune supression and during epidemicsimmune supression and during epidemics

Fetal RiskFetal Risk Transplacental transmission rate is Transplacental transmission rate is ~30%~30% Can cause hepatitis and myocarditisCan cause hepatitis and myocarditis 20% risk of fetal death in the 120% risk of fetal death in the 1stst trimester trimester Causes up to 3% of miscarriagesCauses up to 3% of miscarriages Risk of hydrops is greatest in the second Risk of hydrops is greatest in the second

trimestertrimester When a fetal death rate of about 15%When a fetal death rate of about 15% But by 20w the risk of fetal death has fallen to But by 20w the risk of fetal death has fallen to

6%6%

Treatment of Intrauterine Treatment of Intrauterine Parvovirus InfectionParvovirus Infection

Termination of a pregnancy is not requiredTermination of a pregnancy is not required Weekly ultrasound monitoring for signs of Weekly ultrasound monitoring for signs of

hydrops and middle cerebral Dopplers may be hydrops and middle cerebral Dopplers may be undertaken after documented evidence of undertaken after documented evidence of maternal infectionmaternal infection

But most affected fetus will recover But most affected fetus will recover spontaneouslyspontaneously

A small number may require intrauterine A small number may require intrauterine transfusion for severe anaemiatransfusion for severe anaemia

This is This is ~85% successful~85% successful

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