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Parvovirus B19 in Pregnancy

NICE CKS Parvovirus B19 infection. Last revised Feb 2022.

Guidelines

Urgent testing for:

Prvovirus B19-specific serology (IgM and IgG)
- If parvovirus B10-specific IgM is detected → suggest recent infection
- Confirm diagnosis with high-titre viral DNA PCR or parvovirus B19-specific IgG

Rubella serology (irrespective of any previous testing or immunisation status)

The above is a simplified version (sufficient for exams), see below for full guidance. As the approach differ slightly depending on whether it is suspected infection of exposure to the virus.

Order urgent parvovirus B19-specific IgM

-ve IgM → excludes infection in the 4 weeks prior blood test
- Note if the test is taken >4 weeks after rash onset / illness → unable to exclude infection, seek specialist advice

+ve IgM → suggest recent infection → confirm diagnosis with high-titre viral DNA PCR or parvovirus B19-specific IgG

Urgent testing for rubella should also be arranged (irrespective of any previous testing or immunisation status).

Order urgent parvovirus B19-specific IgG and IgM

Test result	Interpretation	Subsequent Action
-ve IgM and +ve IgG	Past infection, no recent infection	Re-testing not necessary
+ve IgM (irrespective of IgG result)	Suggest recent infection	Confirm diagnosis with antenatal booking blood sample / repeat blood test after 7-10 days
-ve IgM and -ve IgG	Susceptible to infection	Repeat blood test 1 month after last contact (even if asymptomatic or earlier if symptoms develop)

Urgent testing for rubella should also be arranged (irrespective of any previous testing or immunisation status).

Urgent referral to fetal medicine specialist for:

Serial fetal ultrasound scans and Doppler (to detect fetal anaemia, heart failure and hydrops)

If there is suspected fetal hydrops:

Amniotic fluid sample for parvovirus B19 virus DNA detection
Fetal blood sampling + intrauterine RBC transfusion may reduce fetal mortality rate

References

NICE CKS Parvovirus B19 infection

Author: Adams Lau
Reviewer:
Last edited: 27/04/25

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