Management of proven infection (with rubella, parvovirus, measles, enterovirus, infectious mononucleosis)
Specific infections:
Rubella - primary and reinfection
The management of primary rubella or symptomatic rubella reinfection would depend on the gestation of pregnancy at which rubella occurred, and the individual circumstances of the woman ( see Table 1: Characteristics of rubella, parvovirus B19, varicella-zoster virus infections in the UK ).
If a case of asymptomatic rubella reinfection is identified or suspected, management would, as for primary rubella, depend on the gestation of pregnancy and the individual circumstances of the woman. Given the low but definite risk to the fetus of maternal rubella reinfection in the first 16 weeks of pregnancy, there may be occasions when consideration is given to further fetal investigation by genome detection to ascertain if fetal infection has occurred. A range of possible approaches have been explored, but they are all invasive (eg amniocentesis, fetal blood sampling) and carry a risk of adverse outcome.
The necessary virological techniques for fetal investigation are not validated and available in the UK, and laboratory-based members of the Working Group should be consulted for advice if such approaches are being considered: it is strongly advised that management is based on risk assessment.
The management of proven parvovirus B19 infection has become more active with the demonstration that intrauterine transfusion of the fetus improves the outcome ( 33). The following management is suggested ( see algorithm 3: Management of confirmed parvovirus B19 infection in pregnancy):
- On diagnosis of parvovirus B19 infection, ultrasound scanning of the fetus is started 4 weeks post onset of illness or date of seroconversion, and then at 1-2 weekly intervals until 30 weeks gestation.
- If findings suggestive of hydrops fetalis, or its development, are found, the patient should be referred to a Regional Unit for Fetal Medicine for consideration of fetal blood sampling and intrauterine transfusion. Further techniques are becoming available which may assist in fetal assessment, to include Doppler assessment of the middle cerebral artery for anaemia and parvovirus B19 genome detection in amniotic fluid.
Measles, enterovirus, infectious mononucleosis
The management of the pregnancy in these infections is expectant, although follow-up of the infant should be considered even though no congenital infection and damage would be anticipated .
- Algorithm 3: Management of confirmed parvovirus B19 infection in pregnancy
Added/updated: 18 December 2008
