O&G · Antenatal care — perinatal infections
Perinatal infections II: CMV, parvovirus B19, varicella, rubella and Zika
Also known as Congenital cytomegalovirus · CMV in pregnancy · Parvovirus B19 · Slapped cheek disease · Congenital varicella syndrome · Congenital rubella syndrome · Congenital Zika syndrome · TORCH infections
Exam-exhaustive FRANZCOG reference on the five vertical-transmission viral infections a candidate must hold — CMV (trimester-by-trimester transmission, primary vs recurrent, the valaciclovir treatment and secondary-prevention evidence, hygiene prevention), parvovirus B19 (erythroid progenitor tropism, MCA-PSV surveillance, intrauterine transfusion), varicella (VZIG and aciclovir post-exposure, congenital varicella syndrome risk by gestation), rubella (the CRS triad and pre-pregnancy MMR), and Zika (travel, mosquito and sexual-transmission prevention). RANZCOG C-Obs 64 anchored, globally tagged to MRCOG and ABOG.
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8 MCQs with explanations
Target exams
Red flags
A childcare worker at 9 weeks books in for her first antenatal visit, a teacher at 20 weeks is sent up with a hydropic fetus after a slapped-cheek outbreak, and a returning traveller asks whether her recent rash was Zika. Three women, one question for you: which infection, what is the fetal risk, and what do you do today. This topic is the answer, organised the way the station asks it.[5][9]
Overview and definition
These five viruses share one thing — they cross the placenta and damage the developing fetus — and differ on almost everything else: transmissibility, the gestational window of risk, the preventability, and the treatment. The candidate who holds the five in one frame, but treats each on its own numbers, passes this station.[5][9]
CMV
- Commonest congenital infection (~0.64% birth prevalence)
- Primary transmits ~32%, recurrent ~1.4%
- Teratogenic to the developing brain; sensorineural hearing loss is the key long-term sequela
- No vaccine; hygiene is primary prevention
- High-dose valaciclovir 8 g/day for treatment and secondary prevention
Parvovirus B19
- ~30% vertical transmission on maternal infection
- Tropism for erythroid progenitors via the P antigen
- Causes fetal anaemia, high-output failure, hydrops
- MCA-PSV surveillance; intrauterine transfusion for severe anaemia
- Survival with IUT is high (~85% in severe hydrops)
Varicella
- Congenital syndrome risk concentrated before 20 weeks
- Highest risk 13 to 20 weeks (~2%); under 13 weeks ~0.4%
- Maternal zoster carries essentially no fetal risk
- Post-exposure VZIG or aciclovir within the window
- Postpartum vaccine for the non-immune
Rubella / Zika
- Rubella: CRS triad of cataracts, cardiac, deafness; pre-pregnancy MMR prevents it
- Rubella: risk concentrated in first trimester; vaccines since 1969
- Zika: congenital Zika syndrome — microcephaly with intracranial calcifications
- Zika: travel, mosquito and sexual-transmission prevention
- Zika: adverse outcomes regardless of trimester
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Obstetrics & Gynaecology fellowship atlas.
References18Show ledgerHide ledger
- [1]Kenneson A, Cannon MJ Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection Rev Med Virol, 2007.PMID 17579921
- [2]Enders G, Daiminger A, Bäder U, et al. Intrauterine transmission and clinical outcome of 248 pregnancies with primary cytomegalovirus infection in relation to gestational age J Clin Virol, 2011.PMID 21820954
- [3]Leruez-Ville M, Ghout I, Bussières L, et al. In utero treatment of congenital cytomegalovirus infection with valacyclovir in a multicenter, open-label, phase II study Am J Obstet Gynecol, 2016.PMID 27083761
- [4]Faure-Bardon V, Fourgeaud J, Stirnemann J, Leruez-Ville M, Ville Y Secondary prevention of congenital cytomegalovirus infection with valacyclovir following maternal primary infection in early pregnancy Ultrasound Obstet Gynecol, 2021.PMID 33998084
- [5]Rawlinson WD, Boppana SB, Fowler KB, et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy Lancet Infect Dis, 2017.PMID 28291720
- [6]Cannon MJ, Westbrook K, Levis D, Schleiss MR, Thackeray R, Pass RF Awareness of and behaviors related to child-to-mother transmission of cytomegalovirus Prev Med, 2012.PMID 22465669
- [7]Sorrenti S, Deuster E, D'Antonio F, Di Mascio D, Khalil A Parvovirus B19 infection in pregnancy: perinatal outcomes derived from a systematic review and meta-analysis Am J Obstet Gynecol, 2026.PMID 41819197
- [8]Enders M, Weidner A, Zoellner I, Searle K, Enders G Fetal morbidity and mortality after acute human parvovirus B19 infection in pregnancy: prospective evaluation of 1018 cases Prenat Diagn, 2004.PMID 15300741
- [9]Boissiere J, Watkins V, Kuller JA, Dotters-Katz SK Parvovirus B19 in Pregnancy Obstet Gynecol Surv, 2024.PMID 38764205
- [10]Mari G, Norton ME, Stone J, Berghella V, Sciscione AC, Tate D, Schenone MH Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: the fetus at risk for anemia--diagnosis and management Am J Obstet Gynecol, 2015.PMID 25824811
- [11]Enders G, Miller E, Cradock-Watson J, Bolley I, Ridehalgh M Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases Lancet, 1994.PMID 7802767
- [12]Swamy GK, Dotters-Katz SK Safety and varicella outcomes after varicella zoster immune globulin administration in pregnancy Am J Obstet Gynecol, 2019.PMID 31279845
- [13]Sile B, Brown KE, Gower C, et al. Effectiveness of oral aciclovir in preventing maternal chickenpox: A comparison with VZIG J Infect, 2022.PMID 35659543
- [14]Brasil P, Pereira JP Jr, Moreira ME, et al. Zika Virus Infection in Pregnant Women in Rio de Janeiro N Engl J Med, 2016.PMID 26943629
- [15]Oduyebo T, Polen KD, Walke HT, et al. Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States (Including U.S. Territories), July 2017 MMWR Morb Mortal Wkly Rep, 2017.PMID 28749921
- [16]Polen KD, Gilboa SM, Hills S, et al. Update: Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Men with Possible Zika Virus Exposure - United States, August 2018 MMWR Morb Mortal Wkly Rep, 2018.PMID 30091965
- [17]Bouthry E, Picone O, Hamdi G, Grangeot-Keros L, Ayoubi JM, Vauloup-Fellous C Rubella and pregnancy: diagnosis, management and outcomes Prenat Diagn, 2014.PMID 25066688
- [18]Dahlke M, Dautel KA, Vynnycky E, et al. Progress Toward Rubella and Congenital Rubella Syndrome Elimination - Worldwide, 2012-2024 MMWR Morb Mortal Wkly Rep, 2026.PMID 42490629