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[Parvovirus B19 infection and pregnancy]
L Savey1, M H Poissonnier, M Leblanc
1Service de Gynécologie-Obstétrique, CMC Foch, Suresnes.
Summary
Parvovirus B19 infection can cause significant health issues in adults and poses a high risk of fetal anasarca in pregnant women. Diagnosis and management, including potential in utero transfusions, are critical for fetal outcomes.
Area of Science:
- Virology
- Immunology
- Obstetrics
Context:
- Parvovirus B19, identified in 1975, causes erythema infectiosum (fifth disease) in children and adults, with potential complications like arthropathy.
- High transmission rates are observed in school settings, posing risks to teachers and personnel.
- The virus was linked to fetal hydrops (anasarca) in 1984, highlighting its teratogenic potential.
Purpose:
- To review the clinical manifestations, diagnostic approaches, and management strategies for Parvovirus B19 infection, particularly concerning fetal outcomes.
- To discuss the risks associated with parvovirus B19 during pregnancy, including transplacental transmission and potential fetal complications.
- To evaluate the efficacy and indications for antenatal interventions such as intrauterine transfusions.
Summary:
- Parvovirus B19 infection presents with rash and joint pain in adults; approximately 50% of the adult population possesses immunity.
- Transplacental transmission risk is estimated at 33%, potentially leading to fetal anasarca, anemia, and intrauterine fetal death.
- Diagnosis involves PCR on fetal blood; while intrauterine transfusion was proposed, its necessity is debated due to favorable outcomes in some untreated cases, especially considering potential myocardial damage and severe associated thrombocytopenia.
Impact:
- Highlights the importance of monitoring pregnant women with confirmed Parvovirus B19 infection via regular ultrasounds.
- Emphasizes the diagnostic role of PCR in fetal blood for accurate identification of fetal infection.
- Informs clinical decision-making regarding the necessity and potential limitations of intrauterine transfusions for parvovirus B19-related fetal complications.