From the Guidelines
Parvovirus B19 infection is more likely associated with intrauterine fetal death (IUFD) compared to varicella. This is because maternal parvovirus B19 infection, especially during the first 20 weeks of pregnancy, can lead to severe fetal anemia by directly infecting and destroying erythroid progenitor cells in the fetal bone marrow, as reported in the study by 1. The severe anemia caused by parvovirus B19 infection can result in high-output cardiac failure, hydrops fetalis, and ultimately intrauterine fetal death in approximately 5-10% of infected fetuses, with the risk being highest when maternal infection occurs between 9-20 weeks gestation when fetal red blood cell production is primarily in the liver and the fetus has a shorter red cell lifespan. While varicella (chickenpox) during pregnancy can cause complications including congenital varicella syndrome with limb hypoplasia, skin scarring, and neurological abnormalities, it less commonly results in IUFD, as noted in the study by 1. Management of confirmed maternal parvovirus infection includes serial ultrasounds to monitor for signs of fetal anemia or hydrops, with consideration for intrauterine transfusion if severe fetal anemia develops, which can significantly improve survival rates in hydropic fetuses, as shown in the studies by 1 and 1. Key points to consider in the management of parvovirus B19 infection in pregnancy include:
- Serial ultrasounds to monitor for signs of fetal anemia or hydrops
- Consideration for intrauterine transfusion if severe fetal anemia develops
- Awareness of the potential for delayed psychomotor development and abnormal neurological outcomes in survivors of nonimmune hydrops fetalis, as reported in the study by 1. Overall, the evidence suggests that parvovirus B19 infection is a significant risk factor for IUFD, and prompt diagnosis and management are essential to improve outcomes, as emphasized in the study by 1.
From the Research
Infection Association with IUFD
- Parvovirus B19 infection is a significant cause of Intrauterine Fetal Death (IUFD) due to its effects on fetal erythropoiesis, leading to anemia, hydrops fetalis, and ultimately fetal death 2, 3, 4, 5, 6.
- The risk of fetal death is higher when maternal parvovirus B19 infection occurs before 20 weeks of gestation 5.
- Varicella infection is not mentioned in the provided studies as a common cause of IUFD, whereas parvovirus B19 is consistently associated with IUFD in the literature 2, 3, 4, 5, 6.
Comparison of Infections
- Parvovirus B19 infection can cause severe hydrops fetalis, which may result in fetal death if left untreated 3, 5, 6.
- In contrast, there is no direct evidence in the provided studies linking varicella infection to IUFD, making parvovirus B19 a more likely cause of IUFD based on the available data 2, 3, 4, 5, 6.