Refining the prognosis of fetuses infected with Cytomegalovirus in the first trimester of pregnancy by serial prenatal assessment: a single-centre retrospective study.
Abortion, Eugenic
/ statistics & numerical data
Adult
Autopsy
Brain
/ diagnostic imaging
Cytomegalovirus
/ isolation & purification
Cytomegalovirus Infections
/ diagnosis
Female
Fetal Diseases
/ etiology
France
Humans
Infant
Infant, Newborn
Magnetic Resonance Imaging
/ methods
Male
Polymicrogyria
/ etiology
Predictive Value of Tests
Pregnancy
Pregnancy Complications, Infectious
/ diagnosis
Pregnancy Trimesters
Prognosis
Ultrasonography, Prenatal
/ methods
Congenital Cytomegalovirus infection
cordocentesis
magnetic resonance imaging
prognostic
ultrasound
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
accepted:
27
08
2019
pubmed:
11
9
2019
medline:
29
1
2020
entrez:
11
9
2019
Statut:
ppublish
Résumé
To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection <14 weeks of gestation, at different time points of pregnancy: the end of the second trimester; following prenatal magnetic resonance imaging (MRI) at 32 weeks of gestation; and using all ultrasound scans performed in the third trimester (US3rdT). A retrospective study. Reference fetal medicine unit. Sixty-two fetuses infected <14 weeks of gestation. We defined second-trimester assessment (STA) as the combination of ultrasound findings <28 weeks of gestation and fetal platelet count at cordocentesis. Three groups were defined: normal, extracerebral, and cerebral STA. For each group, the PV of STA alone, STA + MRI, and STA + US3rdT were assessed retrospectively. Outcome at birth and at follow-up were reported. The STA was normal, and with extracerebral and cerebral features, in 43.5, 42.0, and 14.5%, respectively. The negative PV of normal STA and MRI for moderate to severe sequelae was 100%. The residual risk was unilateral hearing loss in 16.7% of cases. Of pregnancies with cerebral STA, 44% were terminated. Following extracerebral STA, 48% of neonates were symptomatic and 30% had moderate to severe sequelae. In those cases, the positive and negative PV of MRI for sequelae were 33 and 73%, respectively. STA + US3rdT had a lower negative PV than MRI for symptoms at birth and for moderate to severe sequelae. Any false-positive findings at MRI were mostly the result of hypersignals of white matter. Serial assessment in the second and third trimesters by ultrasound and MRI is necessary to predict the risk of sequelae occurring in 35% of pregnancies following fetal infection in the first trimester of pregnancy. Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.
Identifiants
pubmed: 31505103
doi: 10.1111/1471-0528.15935
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
355-362Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019 Royal College of Obstetricians and Gynaecologists.
Références
Faure-Bardon V, Magny J-F, Parodi M, Couderc S, Garcia P, Maillotte A-M, et al. Sequelae of congenital cytomegalovirus (cCMV) following maternal primary infection are limited to those acquired in the first trimester of pregnancy. Clin Infect Dis 2018; https://doi.org/10.1093/cid/ciy1128 [Epub ahead of print]
Lipitz S, Yinon Y, Malinger G, Yagel S, Levit L, Hoffman C, et al. Risk of cytomegalovirus-associated sequelae in relation to time of infection and findings on prenatal imaging. Ultrasound Obstet Gynecol 2013;41:508-14.
Pass RF, Fowler KB, Boppana SB, Britt WJ, Stagno S. Congenital cytomegalovirus infection following first trimester maternal infection: symptoms at birth and outcome. J Clin Virol 2006;35:216-20.
Picone O, Vauloup-Fellous C, Cordier AG, Guitton S, Senat MV, Fuchs F, et al. A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome. Prenat Diagn 2013;33:751-8.
Guerra B, Simonazzi G, Puccetti C, Lanari M, Farina A, Lazzarotto T, et al. Ultrasound prediction of symptomatic congenital cytomegalovirus infection. Am J Obstet Gynecol 2008;198:380.e1-7.
Cannie MM, Devlieger R, Leyder M, Claus F, Leus A, De Catte L, et al. Congenital cytomegalovirus infection: contribution and best timing of prenatal MR imaging. Eur Radiol 2016;26:3760-9.
Doneda C, Parazzini C, Righini A, Rustico M, Tassis B, Fabbri E, et al. Early cerebral lesions in cytomegalovirus infection: prenatal MR imaging. Radiology 2010;255:613-21.
Benoist G, Salomon LJ, Jacquemard F, Daffos F, Ville Y. The prognostic value of ultrasound abnormalities and biological parameters in blood of fetuses infected with cytomegalovirus. BJOG 2008;115:823-9.
Leruez-Ville M, Stirnemann J, Sellier Y, Guilleminot T, Dejean A, Magny J-F, et al. Feasibility of predicting the outcome of fetal infection with cytomegalovirus at the time of prenatal diagnosis. Am J Obstet Gynecol 2016;215:342.e1-9.
Romanelli RM, Magny JF, Jacquemard F. Prognostic markers of symptomatic congenital cytomegalovirus infection. Braz J Infect Dis 2008;12:38-43.
Fabbri E, Revello MG, Furione M, Zavattoni M, Lilleri D, Tassis B, et al. Prognostic markers of symptomatic congenital human cytomegalovirus infection in fetal blood. BJOG 2011;118:448-56.
Benoist G, Salomon LJ, Mohlo M, Suarez B, Jacquemard F, Ville Y. Cytomegalovirus-related fetal brain lesions: comparison between targeted ultrasound examination and magnetic resonance imaging. Ultrasound Obstet Gynecol 2008;32:900-5.
Enders M, Daiminger A, Exler S, Ertan K, Enders G, Bald R. Prenatal diagnosis of congenital cytomegalovirus infection in 115 cases: a 5 years’ single center experience. Prenat Diagn 2017;37:389-98.
Leruez-Ville M, Ghout I, Bussières L, Stirnemann J, Magny J-F, Couderc S, et al. In utero treatment of congenital cytomegalovirus infection with valacyclovir in a multicenter, open-label, phase II study. Am J Obstet Gynecol 2016;215:462.e1-10.