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What is parvovirus B19 What is the incidence of parvovirus B19 infection in pregnant women What is the transmission rate of parvovirus B19 from an infected woman to her fetus How is parvovirus diagnosed Describe the major manifestations of infection with parvovirus B19 A single-stranded DNA virus 3 4% Approximately 20% it is the highest if infection occurs between 10 and 20 weeks of gestation Serologic testing of IgM and IgG antibodies A self-limited infection known as erythema infectiosum or fifth disease that consists of:
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Section III: Topics in Obstetrics
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Dermatologic manifestations a slapped cheek appearance on the face and a lace-like erythematous rash on the trunk and extremities Symmetric arthropathy Flu-like symptoms What are the manifestations of parvovirus B19 during pregnancy Fetal loss or hydrops fetalis may ensue; however, there are no longterm developmental sequelae if a normal pregnancy ensues If infection occurs before 20 weeks, it is 11% If infection occurs after 20 weeks, it is <1% Generalized fetal edema Destruction of RBC precursors leading to fetal anemia Myocarditis leading to fetal myocardial dysfunction What is the risk of hydrops fetalis What do the following serologic results signify Less than 4% Positive IgG and negative IgM: Prior maternal immunity Positive IgM and negative IgG: Acute infection How should an infected pregnant woman be managed Prior to 20 weeks, no action is necessary After 20 weeks, women should receive weekly ultrasounds to look for signs of hydrops for 10 weeks after infection Elevated peak systolic velocity on the fetal middle cerebral artery dopplers With intrauterine fetal blood transfusion
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What is HIV An RNA retrovirus that incorporates into the host genome and affects primary T cells leading to immunocompromise Enzyme-linked immunosorbent assay (ELISA) testing followed by a Western blot, if the ELISA is positive
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9: Complications of Pregnancy
How do most pediatric HIV infections develop
Through mother-to-child transmission via transplacental infection (50%), peripartum infection (30%), or via breast-feeding (20%) 25%
What is the rate of vertical transmission in an HIV positive woman who is untreated What is the rate of vertical transmission in an HIV positive woman on zidovudine (azidothymidine) ZDV (AZT) alone What is the rate of vertical transmission in an HIV positive woman on HAART (highly active antiretroviral therapy) What are the rates of perinatal HIV transmission in the United States What increases the risk of vertical HIV transmission
1 2%
1 2% they have been dramatically reduced via multiple public health efforts Preterm birth Prolonged ROM Concurrent syphilis infection Chorioamnionitis
What are the two mainstays of prevention of vertical transmission Are adverse pregnancy outcomes more common in HIV infected women
1 Antiretroviral therapy 2 Cesarean delivery Yes Preterm birth and fetal growth restriction are more common, and these rates increase with a decreased CD4 count All pregnant patients, regardless of CD4 count or viral load, should be offered antiretroviral therapy in order to reduce the risk of transmission Once each trimester 4 weeks after any change in therapy, monthly until viral levels are undetectable, every 3 months while the viral load remains undetectable, and then near term Avoid artificial rupture of membranes (HIV transmission increased with increased time after rupture)
Which pregnant patients should be given antiretroviral therapy
When should CD4 counts be measured during pregnancy When should the viral load be measured during pregnancy
What are some of the intrapartum precautions that should be taken
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Section III: Topics in Obstetrics
Use labor augmentation sooner (HIV transmission increased with longer interval to delivery) Give IV zidovudine intrapartum How should the neonate of an HIV infected mother be treated How much does cesarean delivery reduce the risk of vertical HIV transmission With oral zidovudine By half
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