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Important: please update your RDS app to version 4.7.3

Welcome to the March 2025 update from the RDS team

1.     RDS issues - resolutions

1.1 Stability issues - Tactuum implemented a fix on 24th March which we believe has finally addressed the stability issues experienced over recent weeks.  The issue seems to have been related to the new “Tool export” function making repeated calls for content when new toolkit nodes were opened in Umbraco. No outages have been reported since then, and no performance issues in the logs, so fingers crossed this is now resolved.

1.2 Toolkit URL redirects failing– these were restored manually for the antimicrobial calculators on the 13th March when the issue occurred, and by 15th March for the remainder. The root cause was traced to adding a new hostname for an app migrated from another health board and made live that day. This led to the content management system automatically creating internal duplicate redirects, reaching the maximum number of permitted redirects and most redirects therefore ceasing to function.

This issue should not happen again because:

  • All old apps are now fully migrated to RDS. The large number of migrations has contributed to the high number of automated redirects.
  • If there is any need to change hostnames in future, Tactuum will immediately check for duplicates.

1.3 Gentamicin calculators – Incidents have been reported incidents of people accessing the wrong gentamicin calculator for their health board.  This occurs when clinicians are searching for the gentamicin calculator via an online search engine - e.g. Google - rather than via the health board directed policy route. When accessed via an external search engine, the calculator results are not listed by health board, and the start page for the calculator does not make it clearly visible which health board calculator has been selected.

The Scottish Antimicrobial Prescribing Group has asked health boards to provide targeted communication and education to ensure that clinicians know how to access their health board antimicrobial calculators via the RDS, local Intranet or other local policy route. In terms of RDS amendments, it is not currently possible to change the internet search output, so the following changes are now in progress:

  • The health board name will now be displayed within the calculator and it will be made clear which boards are using the ‘Hartford’ (7mg/kg) higher dose calculator
  • Warning text will be added to the calculator to advise that more than one calculator is in use in NHS Scotland and that clinicians should ensure they access the correct one for their health board. A link to the Right Decision Service list of health board antimicrobial prescribing toolkits will be included with the warning text. Users can then access the correct calculator for their Board via the appropriate toolkit.

We would encourage all editors and users to use the Help and Support standard operating procedure and the Editors’ Teams channel to highlight issues, even if you think they may be temporary or already noted. This helps the RDS team to get a full picture of concerns and issues across the service.

 

2.     New RDS presentation – RDS supporting the patient journey

A new presentation illustrating how RDS supports all partners in the patient journey – multiple disciplines across secondary, primary, community and social care settings – as well as patients and carers through self-management and shared decision-making tools – is now available. You will find it in the Promotion and presentation resources for editors section of the Learning and support toolkit.

3.     User guides

A new user guide is now available in the Guidance and tips section of Resources for providers within the Learning and Support area, explaining how to embed content from Google Calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream and Jotforms into RDS pages. A webinar for editors on using this new functionality is scheduled for 1 May 3-4 pm (booking information below.)

A new checklist to support editors in making all the checks required before making a new toolkit live is now available at the foot of the “Request a new toolkit” standard operating procedure. Completing this checklist is not a mandatory part of the governance process, but we would encourage you to use it to make sure all the critical issues are covered at point of launch – including organisational tags, use of Alias URLs and editorial information.

4.Training sessions for RDS editors

Introductory webinars for RDS editors will take place on:

  • Tuesday 29th April 4-5 pm
  • Thursday 1st May 4-5 pm

Special webinar for RDS editors – 1 May 3-4 pm

This webinar will cover:

  1. a) Use of the new left hand navigation option for RDS toolkits.
  2. b) Integration into RDS pages of content from external sources, including Google Calendar, Google Maps and simple Jotforms calculators.

Running usage statistics reports using Google analytics

  • Wednesday 23rd April 2pm-3pm
  • Thursday 22nd May 2pm-3pm

To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.

5.New RDS toolkits

The following toolkits were launched during March 2025:

SIGN guideline - Prevention and remission of type 2 diabetes

Valproate – easy read version for people with learning disabilities (Scottish Government Medicines Division)

Obstetrics and gynaecology induction toolkit (NHS Lothian) – password-protected, in pilot stage.

Oral care for care home and care at home services (Public Health Scotland)

Postural care in care homes (NHS Lothian)

Quit Your Way Pregnancy Service (NHS GGC)

 

6.New RDS developments

Release of the redesign of RDS search and browse, archiving and version control functionality, and editing capability for shared content, is now provisionally scheduled for early June.

The Scottish Government Realistic Medicine Policy team is leading development of a national approach to implementation of Patient-Reported Outcome Measures (PROMs) as a key objective within the Value Based Health and Care Action Plan. The Right Decision Service has been commissioned to deliver an initial version of a platform for issuing PROMs questionnaires to patients, making the PROMs reports available from patient record systems, and providing an analytics dashboard to compare outcomes across services.  This work is now underway and we will keep you updated on progress.

The RDS team has supported Scottish Government Effective Prescribing and Therapeutics Division, in partnership with Northern Ireland and Republic of Ireland, in a successful bid for EU funding to test develop, implement and assess new integrated care pathways for polypharmacy, including pharmacogenomics. As part of this project, the RDS will be working with NHS Tayside to test extending the current polypharmacy RDS decision support in the Vision primary care electronic health record system to include pharmacogenomics decision support.

7. Implementation projects

We have just completed a series of three workshops consulting on proposed improvements to the Being a partner in my care: Realistic Medicine together app, following piloting on 10 sites in late 2024. This app has been commissioned by Scottish Government Realistic Medicine to support patients and citizens to become active partners in shared decision-making and encouraging personalised care based on outcomes that matter to the person. We are keen to gather more feedback on this app. Please forward any feedback to ann.wales3@nhs.scot

 

 

Parvovirus B19 Exposure in Pregnancy (593)

Objectives

Parvovirus B19 Exposure In Pregnancy

This guideline explains the actions to be taken when a pregnant woman discloses exposure to parvovirus during pregnancy, or, when a pregnant woman attends a healthcare setting with clinical features suggestive of parvovirus infection. It aims to standardize care, and ensure optimum diagnosis of parvovirus infection in pregnant women.

Audience

  • Maternity Services across NHS Greater Glasgow and Clyde
  • Maternity Services in NHS Highland where NHS Greater Glasgow and Clyde are contracted to provide secondary maternity care
  • Primary and Secondary Care services in both Boards as described above

Please report any inaccuracies or issues with this guideline using our online form

Parvovirus B19 is a single-stranded DNA virus, and a member of the Parvoviridae virus family. Parvovirus infections are species specific, and exposure to animal parvovirus will not cause infection in humans[i]. It is not a notifiable disease.

In non-pregnant adults with no other co-morbidities, parvovirus infection is usually mild and self-limiting. Parvovirus in children causes a febrile infection with a characteristic facial rash commonly known as Slapped Cheek, but also known as erythema infectiosum, or fifth disease.

In pregnant women there is the possibility of viral transmission to the fetus. Infection in the first 20 weeks of pregnancy carries a risk of fetal anaemia and hydrops between 3-11%. The development of hydrops after 20 weeks is rare, with an incidence <1%.

Hydrops usually occurs 3-5 weeks after infection, and the risk of fetal death is 50%. Hydrops, and fetal anaemia as a result of parvovirus infection can be treated with intra-uterine transfusion; although this is a complex, technically challenging procedure which requires expertise from a specialist centre.

In the immunosuppressed, chronic anaemia can occur, and in those with haemolytic anaemia, aplastic crisis can result from parvovirus infection.

Between 50-70% of pregnant women are already immune to parvovirus infection. Previous infection confers lifelong immunity.

No vaccine to prevent parvovirus infection is available.  Unselected screening for evidence of previous exposure to parvovirus is not recommended[ii]

The incubation period of parovirus is usually defined by the appearance of the rash, but infections in adults can be asymptomatic. It is estimated to be 13-18 days.

Those who have contracted parvovirus infection are infectious from 7-10 days before the onset of the rash. In asymptomatic women, the infectious period is likely to be over by 21 days from the exposure[iii]

The transmission of the virus to susceptible adults from infectious persons is low, and most commonly occurs in the home. Around 50% of those in prolonged, close contact with an infectious person in their household will develop parvovirus infection. In the community, the risk of infection is estimated to be < 10%.[iii]

Contact is defined as being in the same room (e.g. house or classroom, or a 2-4 bed hospital bay) or a significant period of time (>= 15 minus) or face to face contact with a laboratory-confirmed case of parvovirus infection during the period of maximum infectivity, in the absence of respiratory precautions.

Community midwives, midwives working in maternity triage, GPs and other primary care staff should be aware of the significance of parvovirus infection in pregnancy, and be able to advise pregnant women on appropriate investigation and follow up.

Any staff member performing testing for parvovirus infection should ensure that appropriate follow up arrangements for reviewing results are made, and appropriate onward referral made in the event of a resulting showing active or recent parvovirus infection.

Medical staff working in secondary care maternity services should be aware of the significance of parvovirus infection in pregnancy, and be able to advise pregnant women on appropriate investigation and follow up. Senior medical staff, at middle-grade and consultant level should understand how to interpret ultrasound studies assessing fetal wellbeing in the event of parvovirus infection in pregnancy and be familiar with the process of onward referral in the event of suspicion of fetal anaemia or hydrops.

Pregnant women with suspected parvovirus infection should be advised to attend primary care in the first instance, to reduce the risk of infection to other susceptible adults.

If a pregnant woman attends maternity triage with clinical features of parvovirus infection, or attends unannounced seeking care following contact with active parvovirus infection, they should be placed in a segregated area to avoid exposing other susceptible adults to the risk of infection.

Investigation

  • Confirm gestation of pregnancy
  • Enquire as to date of onset of illness, clinical features and type and distribution of any rash
  • Enquire as to previous history of infection and antibody testing
  • Enquire as to recent travel history, including dates and location
  • Enquire as to any contact with any person with a rash illness, or recent travel
  • Enquire as to the present of other comorbidities including immunosuppression, or a history of haemolytic anaemia (e.g. sickle cell disease, thalassaemia, hereditary spherocytosis)

Diagnosis

Take blood as soon as possible for parovirus IgM and IgG. If a rash has occurred, blood samples should be taken the following day following appearance of the rash. Note that the woman is pregnant and gestation on the clinical request.

If previous immunity to parvovirus is confirmed, usually by testing samples taken at the booking appointment, an alternative cause for the symptoms should be sought, as confirmed immunity is lifelong and further parvovirus infection cannot occur.

If the woman is parvovirus naive, current samples will be tested to ascertain if there are signs of ongoing infection, or if seroconversion (and therefore, infection with parvovirus at an earlier gestation) has occurred.

For patients who are immunocompromised, or those at risk of aplastic anaemia, a full blood count and reticulocyte count should be taken at the time of taking the parvovirus tests.

A lack of IgM, excludes current and previous parvovirus infection within the last 4 weeks before the sample was takenii,and excludes parvovirus as a cause of the symptoms. An alternative diagnosis should be sought.

Management

Paracetamol can be used for symptom relief.

The infected woman with a rash can be reassured that they are no longer infectious as the disease is no longer contagious at the onset of the rash.  

Urgent advice from the local haematology service should be sought for women with a history of haemolytic anaemia, as infection with parvovirus can lead to aplastic crisis.

Women at risk of aplastic crisis presenting with symptoms of breathlessness, light-headedness, lethargy or confusion, should be admitted to the antenatal ward for urgent investigation.

Confirmed parvovirus infection in pregnant womem should be referred to secondary maternity services for follow up. An ultrasound scan to perform Middle Cerebral Artery Dopplers to ascertain peak systolic velocity (MCA- PSV) and review by the named Obstetric Consultant should be undertaken as soon as possible.

Middle Cerebral Artery Dopplers should be performed fortnightly for 12 weeks after infection. In the event of diagnosing fetal hydrops, or finding a Middle Cerebral Artery Peak Systolic Velocity > 1.5 MOM, urgent referral to the Fetal Medicine Unit at the QUEH should be arranged. The appropriate online referral form should be completed, and the unit telephoned on ext 64339 (0141 232 4339) to inform them of the urgent referral.

Pregnant women with suspected parvovirus infection should be advised to attend primary care in the first instance, to reduce the risk of infection to other susceptible adults.

Investigation

  • Confirm gestation of pregnancy
  • Enquire as to whether the infection has been confirmed in the contact person
  • Enquire as to when, where and for how long contact took place.
  • Enquire as to previous history of parvovirus infection and antibody testing
  • Enquire as to any history of recent illness
  • Enquire as to the present of other comorbidities, specifically whether there is a history of immunosuppression or haemolytic anaemia

Patients presenting to maternity services with suspected parvovirus exposure for further investigation should be assessed in a segregated area, ideally a single room, and away from other patients pending their test result.

Diagnosis

Take blood as soon as possible for parovirus IgM and IgG. If a rash has occurred, blood samples should be taken the following day following appearance of the rash. Note that the woman is pregnant and gestation on the clinical request.

If previous immunity to parvovirus is confirmed, no further action is required. Immunity is lifelong and the pregnant woman can be reassured that they are not at risk of contracting parvovirus infection.  

If the woman is parvovirus naive, current samples will be tested to ascertain if there are signs of ongoing infection, or if seroconversion (and therefore, infection with parvovirus at an earlier gestation) has occurred.

Women with chronic haemolytic anaemia, at risk of parvovirus infection, should be advised to contact maternity services if they experience symptoms associated with aplastic crisis: breathlessness, light-headedness, lethargy or confusion.

Management

Confirmed Parvovirus Infection After Initial Exposure

Confirmed parvovirus infection in pregnant women should be referred to secondary maternity services for follow up. An ultrasound scan to perform Middle Cerebral Artery Dopplers and review by the named Obstetric Consultant should be undertaken as soon as possible.

Middle Cerebral Artery Dopplers should be performed fortnightly for 12 weeks after infection. In the event of diagnosing fetal hydrops, or finding a Middle Cerebral Artery Peak Systolic Velocity > 1.5 MOM, urgent referral to the Fetal Medicine Unit at the QUEH should be arranged. The appropriate online referral form should be completed, and the unit telephoned on ext 64339 (0141 232 4339) to inform them of the referral.

Perform fortnightly MCA Dopplers until 12 of weeks since infection. For patients who pose a risk of transmission to susceptible pregnant women (< 21 days since the exposure) they should be advised to take respiratory precautions when attending for ultrasound scan, and wait in a segregated area for their appointment.

No Evidence of Current Parvovirus Infection After Initial Exposure

The pregnant women should be advised that they remain at risk of contractive parvovirus infection, and to contact maternity services for advice if further exposure occurs.

A repeat blood sample for parvovirus IgM and IgG should be taken 4 weeks from the initial exposure.

If this shows evidence of seroconversion, manage as for “confirmed parvovirus infection after initial exposure”

  • Transmission of parvovirus to susceptible adults generally occurs at low rates
  • The greatest risk is in the home, where prolonged close contact is most likely to occur, and the risk of transmission in this circumstances is 50%
  • Pregnant women who are susceptible to parvovirus infection who remain at occupational risk should discuss this with their employer, and be signposted to Guidance for control of Parvovirus B19 infection in healthcare settings and the community. Journal of Public Health, 1999 (Crowcroft et al)
  • Parvovirus is spread by respiratory droplets, and respiratory precautions reduce the risk of infection.

Editorial Information

Last reviewed: 25/03/2025

Next review date: 31/03/2028

Author(s): Dr Sacha Haworth, Consultant Obstetrician, Royal Alexandra Hospital, Paisley.

Version: 2

Approved By: Maternity Clinical Governance Group

Document Id: 593