THE RISK OF PERINATAL LOSSES DUE TO PARVOVIRUS INFECTION DURING PREGNANCY AND WAYS TO PREVENT THEM
Authors: Bila V. , Bondarenko N. , Tyshkevich V. , Vitovsky Y. , Tsapenko T. , Оsadchuk S. 
Published: October 2023

The course of pregnancy in infected women in endemic and epidemic situations is associated with a high risk of perinatal losses. However, there is no specifi c etiotropic therapy for parvovirus infection. Insuffi cient records of clinical forms of the infection, possible subclinical or asymptomatic manifestation during pregnancy, and lack of clear indications for examination, require the implementation of eff ective methods aimed at preventing the negative consequences of parvovirus infection during pregnancy. Undoubtedly, in the time of modern medical achievements, gaining new knowledge about the eff ects of parvovirus infection allows early diagnosis of PV19 in pregnant women. The increasing availability of a procedure such as intrauterine red blood cell transfusion has signifi cantly improved the survival prognosis of fetuses with PV19-induced non-immune hydrops, but there is a lot of imprecise data, as this treatment could not completely prevent fetal death. This made it necessary to defi ne and develop effi ciency criteria for this method of treatment. Taking into account the fact that the frequency of perinatal fetal loss due to parvovirus infection is steadily increasing and the problems of the clinical course of pregnancy as well as the prediction of the consequences of parvovirus infection for the fetus at diff erent stagesof pregnancy have not been resolved yet, the algorithm of pregnancy management in case of possible infection with PV19 should be studied nowadays. All these arguments were the reason for conducting this scientifi c research.The purpose of this work is to reduce the frequency of perinatal losses due to intrauterine infection by developing an algorithm for the management of pregnancy with parvovirus infection. Research materials and methods. The study was conducted within the framework of the research topic of the Department of Obstetrics and Gynecology No. 1 of the Bogomolets National Medical University “Restoration and preservation of reproductive health and quality of life of women with obstetric and gynecological pathology in modern conditions” (state registration number 0113U007336). To achieve the purpose of this work, a screening examination of 1090 pregnant women was performed to detect maternal vulnerability to parvovirus infection. The survey included women who had symptoms of a viral disease during pregnancy or were at a high risk of contact with infected people (worked in healthcare, kindergarten, or school, or had children under the age of 14 at home). At the second stage of the study, a core group of 129 patients with a positive test result for parvovirus B19 was formed. The further course of pregnancy, the delivery, method, and perinatal consequences in these women were analyzed. By decision of Bioethics Commission No.1 on 30.02.2020 the research materials meet the requirements accepted by the international community and the current regulatory and legal acts of Ukraine, and the requirements of the Code of Conduct for doctors of Ukraine.Research results. Based on the study of pregnant women from the risk group of infection, it was established that the frequency of detection of parvovirus infection in the structure of obstetric pathology is 11.8%. The rate of perinatal mortality is particularly high in cases of non-immune dropsy of the fetus due to infection with parvovirus B19, which is 108.6‰. An algorithm for the management of pregnant women was developed, which made it possible to reduce the frequency of perinatal losses with parvovirus infection. This algorithm was implemented thanks to early diagnosis of this pathology among pregnant women with a high risk of the disease, serial determination of alpha- fetoprotein indicators in maternal blood, weekly ultrasound monitoring of the condition of the fetus with Doppler blood fl ow in the middle cerebral artery and ductus venosus of the fetus for 10 weeks. When severe fetal anemia manifested in a fetus with non-immune dropsy, intrauterine blood transfusion sessions were performed, optimally at 23-25 weeks of pregnancy. The eff ectiveness of carrying out blood transfusion for a fetus with non-immune dropsy due to PV19 will be successful if the following criteria are followed, namely: the viral load in the umbilical cord blood does not exceed 4×10×5 MO/ml, max peak systolic blood fl ow velocity in a middle cerebral artery – 1.95±0.4 MOM, gestational age – 24±1.0 (23-25) week, normal indicators of blood fl ow in the venous duct of the fetus, no USG signs of myocarditis. Intrauterine blood transfusion of a fetus with non-immune dropsy due to parvovirus infectionin the II trimester of pregnancy was successful in 72.7% (р=0.005). In the case of detection of both compensated and decompensated umbilical cord artery disorders in the period of 27-32 weeks in the presence of blood fl ow disorders in the ductus venosus, premature delivery by cesarean section was performed.Conclusions. Pregnancy management according to the developed algorithm, in comparison with routine pregnancy management, reduces the relative risk of antenatal fetal death by 21% (р=0.590), the risk of early neonatal mortality by 84% (р=0.003), the risk of perinatal mortality by 77% (р= 0.0004). The obtained data proves the prevailing effi ciency of the proposed algorithm.