Article Text

Investigation and outcome of fetal anaemia in fetal parvovirus infection in pregnancy
  1. A Pandravada,
  2. MA Ledingham
  1. Queen Mother's Hospital, Glasgow, UK

Abstract

Background Parvovirus infection may affect 1–5% of pregnant women. Clinical impact of maternal infection on the fetus is diverse (uncomplicated pregnancy, fetal anaemia, hydrops or intrauterine death). In mothers with proven fetal parvovirus B19 infection ultrasound monitoring of middle cerebral artery peak systolic velocity (MCA-PSV) is used to assess need for intrauterine transfusion (IUT).

Objectives To confirm the correlation between MCA-PSV and fetal anaemia, and evaluate outcome following IUT.

Methodology 10-year retrospective case note analysis of patients with parvovirus B19 infection referred to the fetal medicine at the Queen Mother's hospital, Glasgow.

Results 24 cases were identified from various units within Scotland and Northern Ireland. Data were available in 21 cases. Median age was 29 years. Median gestational age at referral was 21 weeks. All of the patients had positive serology for Parvovirus B19. Ultrasound confirmed hydrops in most patients (pleural effusion, pericardial effusion and ascites). IUT was attempted when MCA-PSV was >1.5 MoMs (19 patients; 1 twin pregnancy).

There was a good correlation between MCA PSV and foetal anaemia (sensitivity 81.2% and PPV 100%). No complications occurred in 84% and cord haematoma and bradycardia occurred in 16%. Overall live birth rate was 53%. In one case conservative management was associated with spontaneous resolution of hydrops.

Conclusion MCA-PSV is a reliable predictor of fetal anaemia in cases of fetal parvovirus infection. Overall survival was 55%. Regular monitoring and timely IUT is the key to management when anaemia is suspected.

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