Parvovirus Infection and Pregnancy Max Brinsmead MB BS PhD May 2015

Parvovirus Caused by Parvovirus B19 Caused by Parvovirus B19 Causes epidemic Fifth Disease or “Slapped Cheek Syndrome” in pre school children. Causes epidemic Fifth Disease or “Slapped Cheek Syndrome” in pre school children. When intrauterine infection occurs it affects haemopoeisis. This results in fetal anaemia and hydrops fetalis. When intrauterine infection occurs it affects haemopoeisis. This results in fetal anaemia and hydrops fetalis. However, recovery is usually spontaneous and complete and there are no long term sequelae However, recovery is usually spontaneous and complete and there are no long term sequelae

Vertical Parvovirus Transmission 50-66% of pregnant women are Parvovirus immune 50-66% of pregnant women are Parvovirus immune Most infections occur from the mother’s own pre school child Most infections occur from the mother’s own pre school child Spread by droplets c sneezing, coughing Spread by droplets c sneezing, coughing Incubation period is days Incubation period is days Rash occurs on the face but also on hands, wrists & knees Rash occurs on the face but also on hands, wrists & knees Maternal symptoms include polyarthalgia, fever and non specific rash Maternal symptoms include polyarthalgia, fever and non specific rash Risk of maternal infection is increased by immune supression and during epidemics Risk of maternal infection is increased by immune supression and during epidemics

Fetal Risk Transplacental transmission rate is ~30% Transplacental transmission rate is ~30% Can cause hepatitis and myocarditis Can cause hepatitis and myocarditis 20% risk of fetal death in the 1 st trimester 20% risk of fetal death in the 1 st trimester Causes up to 3% of miscarriages Causes up to 3% of miscarriages Risk of hydrops is greatest in the second trimester Risk of hydrops is greatest in the second trimester 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 6% But by 20w the risk of fetal death has fallen to 6%

Treatment of Intrauterine Parvovirus Infection Termination of a pregnancy is not required Termination of a pregnancy is not required Weekly ultrasound monitoring for signs of hydrops and middle cerebral Dopplers may be undertaken after documented evidence of maternal infection Weekly ultrasound monitoring for signs of hydrops and middle cerebral Dopplers may be undertaken after documented evidence of maternal infection But most affected fetus will recover spontaneously But most affected fetus will recover spontaneously A small number may require intrauterine transfusion for severe anaemia A small number may require intrauterine transfusion for severe anaemia This is ~85% successful This is ~85% successful

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