Parvovirus infection in pregnancy (Slapped Cheek syndrome)

Parvovirus Infection In Pregnancy (Slapped Cheek Syndrome)

Dr ‘Funmi Odusoga MRCOG Consultant O&G

Table of content

1. Incidence/Epidemiology

2. Clinical features

3. Investigations

4. Management

5. Prevention

6. Management Flow Chart

7. Reference

Incidence/Epidemiology

• Caused by Human parvovirus b19
• Incubation period 1 – 3weeks
• Incidence of acute B19 infection in pregnancy is 3.3 – 3.8%
• Higher rate of infection in school teachers
• Susceptible individual exposed has 20-30% risk of infection
• 30 – 60% of adults have antibodies to B19
• 30 – 53% of pregnant women have pre-existing IgG

Clinical Features

• Viraemia occurs approximately 5 – 10days after exposure and usually lasts about 7 days
• Infected person is contagious before onset of symptoms
• 25% of patients are asymptomatic
• 50% have non – specific flu like illness
• Immunocompetent individuals can present with arthralgia, arthritis and exanthema
• Individuals are no longer infectious when exhibiting clinical characteristics

Maternal presentation

• Erythema infectiosum / fifth disease
• Arthropathy
• Transient aplastic crisis
• Pure red call aplasia in immunocompromised patients

Fetal presentation

• (The fetus is especially susceptible to the effects of parvovirus B19 induced anaemia due to its shortened Red blood cell half-life, expanding Red Blood Cell volume and immature immune system)
• Fetal death is 6.3% if diagnosed before 20weeks
• 1st trimester fetal death rate 13%
• 9% death rate if 13 – 20weeks gestation
• 0% after 20weeks transient isolated fetal pleural effusion that resolves spontaneously before term
• Fetal hydrops – 3.9%
• Severe thrombocytopaenia
• PARVOVIRUS is not a teratogen

 Investigations

• Radioimmunoassay & Elisa captures about 80-90%of patients with clinical infection
• IgM antibody is detected approximately 10days after exposure and persists for 3 months or longer
• IgG are markers of past infection- Fetus is protected
• IgM is consistent with acute parvovirus infection
• If initial serology is negative do additional screening for maternal B19 DNA

Management

• Do weekly Ultrasound to detect hydrops
• Doppler assessment of fetal middle cerebral artery peak systolic velocity and ductus venous velocity are accurate non-invasive tools for detecting anaemia
• Percutaneous umbilical vein sampling –(Invasive)
• Mild to moderate anaemia is well tolerated by fetus
• Severe anaemia may require transfusion between 18-35weeks
• Parvovirus infection is not an indication for termination of pregnancy

Prevention

Susceptible pregnant women should avoid contact with Parvovirus B19

Management flow chart

Reference