Risk of fetal hydrops and non-hydropic late intrauterine fetal death after gestational parvovirus B19 infection

Enders, Martin; Klingel, Karin; Weidner, Andrea; Baisch, Carola; Kandolf, Reinhard; Schalasta, Gunnar; Enders, Gisela

doi:10.1016/j.jcv.2010.07.014

Cited by 76 publications

(38 citation statements)

References 35 publications

(50 reference statements)

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“…Autopsy confirmed B19V infection in 5/6 fetal losses, with the sixth loss occurring shortly after diagnosis of hydrops. Fetal loss is thought commoner when infection takes place before 20 weeks gestation (Miller et al, 1998;Enders et al, 2010), and was observed in 1/19 (5 %) pregnancies where seroconversion was demonstrable and in 1/7 (14 %) where B19V antibody was already present at the booking appointment. However, the majority of infections during this outbreak were confirmed in pregnancies .20 weeks, and all of the 42 pregnancies monitored had uneventful outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…In England, approximately 40 % of women of child-bearing age are non-immune to B19V, with no systematic seroprevalence data for the rest of the UK or Republic of Ireland (Mossong et al, 2008). While it is a recognized cause of fetal loss, the true extent is still controversial, with studies reflecting both relatively rare fetal involvement (4.2 % loss) (Enders et al, 2010) or relatively high fetal involvement (16 % fetal loss) (Beigi et al, 2008). Relying on research studies for gauging the actual level of loss is no substitute for regular gathering and analysis of accurate routine data at a community level.…”

Section: Introductionmentioning

confidence: 99%

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The lack of routine surveillance of Parvovirus B19 infection in pregnancy prevents an accurate understanding of this regular cause of fetal loss and the risks posed by occupational exposure

Watt

Brown

Pathiraja

et al. 2013

Journal of Medical Microbiology

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In Europe, fetal loss due to Parvovirus B19 (B19V) is under-reported and a poorly addressed occupational risk to pregnant women. This is exemplified internationally, where it was unmentioned in the last two European Centre for Disease Prevention and Control (ECDC) annual surveillance reports or its 2009 special report on infections in pregnancy. To assess this potential for underestimating B19V fetal loss in pregnancy, we undertook a systematic review of practice in Northern Ireland in the management and reporting of B19V infections over a 12-month period of heightened transmission, one of six observed in a span of 9 years. Pregnant and non-pregnant women presented with symptomatic infection in 24 and 93 % of confirmed B19V infections, respectively, with no difference in viral loads. There was underinvestigation of viral causes of fetal loss, with only 143/2739 (5 %) tested for B19V, and a failure to follow up most non-immune women tested following rash contact. Occupational exposure was recorded in 31/60 (51.6 %) of pregnancies audited following rash exposure, the majority teachers or day care workers. Against a background seroprevalence of 66.5 % immunity in women of child-bearing years, two patterns of infection were identified. Firstly, pregnant women investigated for a rash or exposure to slapped cheek syndrome, where an infection incidence of 18 % was observed, resulted in 42 confirmed infections, all proceeding to healthy term deliveries. Secondly, pregnant women with unsuspected infection had six cases of confirmed B19V fetal loss, including four of 22 (18 %) diagnosed at autopsy, of which three were non-hydropic. While many studies have reported B19V fetal loss in pregnancy, there are no robust public health surveillance figures to draw on. That all six confirmed fetal losses came from the small number of miscarriages/stillbirths investigated, 143 out of 2739, suggests inadequate follow-up of those pregnancies where B19V-related fetal loss may be most common, and supports the need for enhanced surveillance pilots to address this significant gap in public health knowledge.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The lack of routine surveillance of Parvovirus B19 infection in pregnancy prevents an accurate understanding of this regular cause of fetal loss and the risks posed by occupational exposure

Watt

Brown

Pathiraja

et al. 2013

Journal of Medical Microbiology

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“…This observation is strictly related to the pathogenesis of fetal damage. During the period from gestational weeks 17 to 24, the placental trophoblasts express elevated concentrations of P antigen, the specific B19 receptor, and a very intense hematopoiesis is located in the liver; thus, the fetus is vulnerable to damage induced by B19 (3,10).…”

Section: Discussionmentioning

confidence: 99%

Gestational and Fetal Outcomes in B19 Maternal Infection: a Problem of Diagnosis

et al. 2011

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Parvovirus B19 infection during pregnancy is a potential hazard to the fetus because of the virus' ability to infect fetal erythroid precursor cells and fetal tissues. Fetal complications range from transitory fetal anemia and nonimmune fetal hydrops to miscarriage and intrauterine fetal death. In the present study, 72 pregnancies complicated by parvovirus B19 infection were followed up: fetal and neonatal specimens were investigated by serological and/or virological assays to detect fetal/congenital infection, and fetuses and neonates were clinically evaluated to monitor pregnancy outcomes following maternal infection. Analysis of serological and virological maternal B19 markers of infection demonstrated that neither B19 IgM nor B19 DNA detected all maternal infections. IgM serology correctly diagnosed 94.1% of the B19 infections, while DNA testing correctly diagnosed 96.3%. The maximum sensitivity was achieved with the combined detection of both parameters. B19 vertical transmission was observed in 39% of the pregnancies, with an overall 10.2% rate of fetal deaths. The highest rates of congenital infections and B19-related fatal outcomes were observed when maternal infections occurred by the gestational week 20. B19 fetal hydrops occurred in 11.9% of the fetuses, and 28.6% resolved the hydrops with a normal neurodevelopment outcome at 1-to 5-year follow-up. In conclusion, maternal screening based on the concurrent analysis of B19 IgM and DNA should be encouraged to reliably diagnose maternal B19 infection and correctly manage pregnancies at risk.Parvovirus B19 is a common human pathogen. The infection can occur asymptomatically, or it can be associated with a broad range of clinical features such as erythema infectiosum, postinfectious arthropathy, or transient aplastic crises in patients with hemolytic anemia and can complicate a pregnancy course. B19 is mainly transmitted via respiratory secretions and vertically by the transplacental route. B19 iatrogenic transmission has also been described by blood products (3).The prevalence of specific B19 IgG ranges from 15 to 60% in children to 30 to 60% in adults and is Ͼ85% in the geriatric population (13,14,18). In pregnant women, susceptibility to B19 infection has been estimated at 26 to 43.5%, with a seroconversion incidence of 0.61 to 2.4%. In an epidemic period, the incidence may increase up to 13.5% (12,15,22).The infection during pregnancy can have very different outcomes, ranging from the absence of maternal and fetal symptoms to transitory fetal anemia and nonimmune hydrops fetalis (NIHF) to miscarriage and intrauterine fetal death (IUFD). Fetal injuries such as fetal myocarditis, endothelial lesions, and fetal cerebral damages have been reported (9,19,21). Thrombocytopenia secondary to B19 infection can also occur (19), as well as congenital anomalies, including chronic anemia (4), meconium peritonitis (24), congenital heart disease (23), fetal hepatic calcifications (20), and bilateral opacification of the cornea (17). The pathogenesis of fetal damages d...

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“…26 On the other hand, Enders et al reported fetal hydrops risk as 4.2% after gestational parvovirus B19 infection. 34 Gratacos et al reported the incidence of acute infection during pregnancy as 3.7% and the incidence of fetal loss caused by parvovirus as 1.66%. 35 The mother of any fetus with hydrops should be investigated for parvovirus B19 infection.…”

Section: Clinical Manifestations and Transmission Of Parvovirus B19 Imentioning

confidence: 99%

“…8 Enders et al reported a higher risk of fetal hydrops in pregnancies affected by B19 between 9 and 20 weeks gestation. 34 In the early second trimester, the reason of increased fetal loss rate is due to the rapid hematopoietic system of the fetus. 36 Also at the second trimester, P antigen is present on the trophoblast layer in the placenta and allows the vertical transmission of parvovirus B19 from infected mother to the fetus.…”

Section: Outcomes Of Parvovirus B19 Infections In Pregnancymentioning

confidence: 99%

Parvovirus B19 Infections in Pregnant Women and Neonates: Review

Kaşifoğlu¹,

Us²

2016

Turkiye Klinikleri J Gynecol Obst

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Risk of fetal hydrops and non-hydropic late intrauterine fetal death after gestational parvovirus B19 infection

Cited by 76 publications

References 35 publications

The lack of routine surveillance of Parvovirus B19 infection in pregnancy prevents an accurate understanding of this regular cause of fetal loss and the risks posed by occupational exposure

The lack of routine surveillance of Parvovirus B19 infection in pregnancy prevents an accurate understanding of this regular cause of fetal loss and the risks posed by occupational exposure

Gestational and Fetal Outcomes in B19 Maternal Infection: a Problem of Diagnosis

Parvovirus B19 Infections in Pregnant Women and Neonates: Review

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