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    ACOG Guidelines at a Glance: Key points about 4 perinatal infections



    Diagnostic points

    Exposure to an infected individual is associated with a 50% risk of maternal infection and 17% to 33% risk of fetal infection. If exposed, a pregnant woman should have IgG and IgM screening. If the anti-parvovirus IgM titer is positive, the woman is presumed to be infected and fetal infection is possible. The fetus of a woman with confirmed new parvovirus infection based on positive IgM should have be monitored for fetal anemia with serial ultrasounds to evaluate for presence of hydrops and placentamegaly, and Doppler interrogation of the middle cerebral artery (MCA) for peak systolic velocity. Elevated MCA Doppler is concerning for fetal anemia.2 MCA Doppler studies should be performed every 1 to 2 weeks for up to 12 weeks after maternal infection.

    New points

    1. Fetuses who had hydrops due to maternal parvovirus infection and required in utero transfusion may have an increase in neurodevelopmental impairment.3

    2. Routine screening of pregnant women for parvovirus IgM should not be performed.

    Level A Recommendation

    Pregnant women with acute parvovirus infection should be evaluated for fetal anemia with serial ultrasound studies, including Doppler assessment of peak systolic velocity of the fetal MCA.

    Varicella Zoster

    Diagnostic points

    Varicella is diagnosed based on typical symptoms. Serology is not generally used for diagnosis. Risk of fetal congenital infection is low (0.4%–2.0%) but neonatal infection when maternal disease occurs between 5 days before delivery until 2 days after delivery is associated with a high rate of neonatal death.

    New points

    1. From 10% to 20% of pregnant women who contract a primary varicella infection will develop pneumonia and maternal risk of death from varicella is as high as 40%. Thus, these patients should be treated with oral acyclovir and varicella-zoster immune globulin (VZIG).

    2. Varicella immunity status should be documented in early pregnancy by history of disease or history of vaccination. If a woman’s history is negative for either disease or vaccination, she can be tested for varicella IgG.

    3. Congenitally infected fetuses with no varicella-associated anatomic abnormalities have normal neurodevelopment.4

    4. Correction: Conception need be delayed by only 1 month after the varicella vaccine is received. The current practice bulletin says 3 months, but this will be corrected by ACOG in early 2016.

    Level A recommendations

    1. Oral acyclovir appears safe and should be considered in pregnant women with varicella lesions. The efficacy of intravenous (IV) acyclovir has not been established but it may reduce maternal morbidity and mortality associated with varicella pneumonia.

    2. Pregnant women who are not immune to varicella and exposed to active varicella should receive VZIG within 96 hours of exposure to prevent or attenuate disease manifestations. (However, please note that it is very difficult to obtain VZIG and it must be gotten directly from the manufacturer [CDC 2013].5)


    Next: Toxoplasmosis  >>


    Sarah J. Kilpatrick, MD, PhD
    Dr. Kilpatrick is the Helping Hand Endowed Chair in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los ...


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