新生儿产前感染__培训课件.pptVIP

* The disease is often asymptomatic. The incubation period is 4-6 days. Phase 1, the viraemic phase is characterised by a slapped cheek rash. Phase 2 , the immune complex phase is characterised by a rash and arthralgia. This latter presentation is the most common clinical picture in adults. * There are 2 scenarios in which you may be called upon to offer to advice to a pregnant women with parvovirus. One scenario is when a pregnant woman is exposed to B19 infection and is worried about her risk of disease. The second is the case of a known affected fetus and what is the likely outcome. * According to the SOCG guidelines and other published literature it appears that 50% of women of childrearing age are susceptible to Parvo virus infection. There is a 1-3% baseline risk of infection in the population, that is without a known exposure. The risks follwing exoposure are quite variable with reports of a 20-30 % conversion rate with an occupational exposure and up to 50% with household contact. The best estimate of risk of vertical transmission to the fetus is 17-33%. Two questions remain What is the incidence of adverse fetal effect given maternal seroconversion? What are the fetal consequences of congenital infection?. * How do we diagnose Fetal parvovirus infection First step is to monitor Maternal serology. both IgG and IgM . Of note Maternal IgM may be negative at the onset of hydrops (14 days) and IgG increases later. If maternal serology indicates that mum has seroconverted then it is really weekly ultrasounds from 2 weeks up to 12 weeks from the time of the infection. * If there is evidence of maternal seroconversion then it is very important to monitor the fetus for hydrops or evidence of impending hydrops as indicated by increasing Middle Cerebral artery peak systolic velocity. MCA psv for short. Of note hydrops secondary to B19 may develop up to 12 weeks from time of infection, most commonly in fetuses 16-32 weeks gestation. The positive predictive