Perinatal consequences of Parvovirus infections C. Hubinont,MD, PhD Saint-Luc University Hospital, Université Catholique de Louvain (UCL) B-1200-Brussels, Belgium.
Fifth disease- erythema infectiosum, Parvovirus B19 infection Viral disease Clinical Cheek skin rash Fever Arthritis Anemia Contamination Airborne droplets (nose-throat)
Pregnancy and HPVB19 50 % seropositive RR among seronegative = 2.8% (higher if other young children) Fetal risks: Miscarriages-IUD 6% Anemia and thrombopenia Hydrops 4% Myocarditis (J.Crane et al, J.Obstet Gynaecol Can 2002, M.Enders et al Prenat Diagn 2004)
Serological diagnosis of HPVB19
Effects of HPVB19 on blood cells Multipotent cells Megacaryocyte Granulocytes Platelets Erythroblaste Erythrocyte
Diagnosis of HPVB19 fetal anemia SINUSOIDAL RYTHM NO
Ultrasound signs of anemia
ASCITES CARDIOMEGALY -FAILURE CARDIAC REGURGITATION
Non invasive diagnosis of anemia resulting from PV infection using mid cerebral artery peak systolic velocity (MCAPSV) Study of 32 fetuses at risk of anemia GA:15-37 17 with MCAPSV > 1.5 MoM 15 with normal result Sensibility 94 % Specificity 93.3 %
HPVB 19 and myocarditis Responsable for hydrops +- anemia Presence of intra nuclear virions using electronic microscopy ( O Malley et al, Ped Dev Pathol 2003) Possible cause for IUD
Treatment - intrauterine transfusion (IUT) Survival rate if transfusion: 82% vs 55% (M.Enders et al Prenat Diagn 2004) Duration of anemia :6 weeks Long term serostatus: no persistent infection (J.Dembinski et al, Arch Dis Child, 2003) Long term outcome after IUT: neuro-development score = normal (J.Dembinski et al, BJOG, 2002) Pontificia Universidad Católica de Chile. 15 de Septiembre del 2005
HPVB19 and US Increased nuchal translucency Meconial péritonitis 4 cases (Zerbini Prenat Diagn 1998)
What to check? What to see? Heart Thorax (effusions) Hydrops (27 % of all causes of hydrops) Abdomen (liver, ascites) Placenta Amniotic fluid index Liver lengh
Management of seroconversion Serological diagnosis (IgM) Weekly US (signs of anemia) during 8-12 w PCR in amniotic fluid fetal blood? If suspicion of anemia: intrauterine blood transfusion