Complications
Parvovirus B19-induced fetal anaemia may result in high-output congestive heart failure and intrauterine death may occur.
The second trimester is the period of highest risk, especially between 20 and 28 weeks.
The risk of trans-placental infection in women infected during pregnancy is approximately 30% and the risk of fetal loss with infection is 8% to 10%, though some believe these risks to be lower than frequently stated.[33]
Referral to an obstetrics consultant is recommended in all pregnant women with suspected parvovirus B19 infection so that fetal haematological parameters can be monitored. Monitoring may include serial ultrasounds and Doppler assessment of the middle cerebral artery, which is an accurate predictor of fetal anaemia.[26]
If the fetus does develop severe anaemia, reported therapies include intrauterine blood transfusions and intravenous immunoglobulin (IVIG).[33][34]
There is controversy about whether the benefit of intrauterine blood transfusion outweighs the risk involved in this treatment for severe fetal anaemia.[35]
IVIG may be beneficial but the evidence is limited.[36]
Transient aplastic crisis, causing a decrease in haemoglobin levels with absent to low reticulocytes during acute infection and resolving within days to weeks, is seen in patients with increased red-cell turnover or destruction.
Aplastic crises are usually transient (self-limited) but can result in severe anaemia that may require intervention with transfusion.[2]
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