Evaluation of patients exposed to parvovirus B19 during pregnancy

Parvovirus B19 infection during pregnancy can have serious adverse effects on the fetus, such as fetal loss or hydrops fetalis, thus evaluation and follow-up are warranted. This algorithm outlines a reasonable approach to a patient with exposure to parvovirus B19 during pregnancy. Nevertheless, patient preference should be taken into account and clinicians should engage in shared decision making with the patient.

PCR: polymerase chain reaction; MCA-PSV: middle cerebral artery peak systolic velocity; Hct: hematocrit; Hb: hemoglobin; MoMs: multiples of the median for gestational age.

* Serial sonographic assessment for anemia is not performed before 18 weeks because intrauterine transfusion is technically difficult before this gestational age.

¶ Severe thrombocytopenia may be present and can lead to exsanguination. The platelet count should be determined, and platelets should be available for transfusion at the time of any fetal procedures.

Δ Severe fetal anemia can be defined as more than two standard deviations below the mean value for gestational age. Refer to UpToDate content for information on fetal hemoglobin values in the second and third trimesters.

◊ Intrauterine transfusion is usually limited to pregnancies <34 weeks of gestation. At ≥34 weeks, delivery for newborn transfusion is generally preferable.

Adapted from: Ornoy A, Ergaz Z. Parvovirus B19 infection during pregnancy and risks to the fetus. Birth Defects Res 2017; 109:311.

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Evaluation of patients exposed to parvovirus B19 during pregnancy