Objective To analyze the outcome of maternal primary cytomegalovirus (CMV) infection.Methods Retrospective analysis of a cohort of 238 patients with maternal primary CMV infection detected at routine screening. The cases were managed with serial ultrasound (US) scans, and amniocentesis was performed in 36.1% of cases. All prenatal results were confirmed at birth. ResultsThe average age was 31.9 (18-44) years. Patients were symptomatic in 21% of cases. The rate of intrauterine transmission was 24.9%, and it was 8.8%, 19%, 30.6%, 34.1% and 40% in the preconceptional period, the periconceptional period, and the first, second and third trimesters of pregnancy, respectively (p = 0.025). There was a significantly higher risk of US abnormalities when maternal infection occurred during the preconceptional or periconceptional period and the first trimester compared with later (p < 0.001). Because of US abnormalities, pregnancy was terminated in 18 cases at the parents' request. Three infected newborns were symptomatic; all three cases were suspected at US before birth. We did not observe any symptomatic fetal infection when maternal infection occurred after 14 weeks of gestation. A number of clinically asymptomatic cases (5.5%) developed hearing loss. ConclusionThe rate of materno fetal transmission is linearly correlated to the gestational age at infection. No severe case of congenital infection was observed if maternal infection occurred after 14 weeks of gestation.

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This review assesses data on the possible relationship between the contractility of the non-pregnant uterus and the human reproduction process. The possibility of assessing non-invasively uterine contractility using ultrasound scans has improved understanding of hormone regulation and the influence of uterine contractility on the human embryo implantation process in both natural and ovarian stimulation cycles. Contractions of the non-pregnant uterus are influenced by ovarian hormones and, presumably, partake in the in-vivo fertilization and embryo implantation processes in humans. Approaches aimed at either stimulating or inhibiting uterine contractions could be instrumental in improving pregnancy rates after the use of assisted reproductive technologies.

Chronic inflammatory processes affecting the endometrium, as encountered in endometriosis, adenomyosis, and chronic endometritis, alter endometrial receptivity. These disorders are associated with early pregnancy losses and possibly recurrent pregnancy losses (RPL). In the cases of endometriosis, other factors associated with the disease also are susceptible of causing miscarriages and possibly RPL, such as an impact of intrapelvic inflammatory processes affecting the oocyte and embryo in case of natural conception. Conversely these latter effects obviously are bypassed in case of assisted reproductive technology. Chronic inflammation of the endometrium in the condition known as chronic endometritis also causes early pregnancy losses and RPL with beneficial effects achieved when specific treatment is undertaken. (Fertil Steril Ò 2021;115:546-60. Ó2020 by American Society for Reproductive Medicine.