Guideline sources The following summarized guidelines for the evaluation and management of parvovirus B19 infection in pregnancy are prepared by our editorial team based on guidelines from the American College of Obstetricians and Gynecologists (ACOG 2015) and the Society of Obstetricians and Gynaecologists of Canada (SOGC 2014). 1 2 Guidelines 1. Screening and diagnosis Indications for screening: as per SOGC 2014 guidelines, do not obtain routine screening for parvovirus B19 immunity in low-risk pregnancies. D 2. Diagnostic investigations Serologic testing: as per SOGC 2014 guidelines, obtain serologic testing to determine susceptibility to infection (non-immune) or a current infection (parvovirus B19 IgG and IgM) in pregnant females exposed to, or developing symptoms of, parvovirus B19 infection. B Show 3 more 3. Patient education General counseling: https://web.pathway.md/diseases/rectCnCIm2aOY3xy4 1/2 6/29/23, 10:54 PM Parvovirus B19 infection in pregnancy Pathway General counseling: Advise pregnant patients non-immune to parvovirus B19 to minimize exposure at work and at home. Consider advising absence from work on a case-by-case basis. B Counsel pregnant patients with a recent diagnosis of parvovirus B19 regarding risks of fetal transmission, fetal loss, and hydrops. B 4. Follow-up and surveillance Indications for referral: Consider referring pregnant patients with a recent diagnosis of parvovirus B19 infection to an obstetrician or a maternal-fetal medicine specialist. C Refer patients with hydrops fetalis or evidence of fetal anemia to a specialist capable of fetal blood sampling and intravascular transfusion. B Serial imaging assessment: as per SOGC 2014 guidelines, obtain serial ultrasound assessment every 1-2 weeks, up to 12 weeks after infection, to detect the development of anemia (using Doppler measurement of the middle cerebral artery PSV) and hydrops fetalis. B Clinical findings Symptoms Past obstetric history Arthralgia Fetal HF Fever Fetal anemia Flu-like symptoms Fetal myocarditis Headache Hydrops fetalis Malaise Stillbirth Myalgia Serological findings Nausea Parvovirus B19 IgG Integument exam Parvovirus B19 IgM Maculopapular rash References 1. Joan Crane, William Mundle, Isabelle Boucoiran et al. Parvovirus B19 infection in pregnancy. J Obstet Gynaecol Can. 2014 Dec;36 12 1107 1116. Open 2. No authors listed. Practice bulletin no. 151 Cytomegalovirus, parvovirus B19, varicella zoster, and toxoplasmosis in pregnancy. Obstet Gynecol. 2015 Jun;125 6 1510 1525. Open https://web.pathway.md/diseases/rectCnCIm2aOY3xy4 2/2