Accuracy of prenatal ultrasound screening to identify fetuses infected by cytomegalovirus which will develop severe long‐term sequelae

Abstract

What are the novel findings of this work? Without cytomegalovirus (CMV) serology screening in pregnancy, routine detailed ultrasound examination identified 26% of infected fetuses that developed severe long-term sequelae, although non-specific infection-related findings had been reported in 64% of cases without raising suspicion. However, targeted ultrasound of known infected fetuses had a sensitivity of 91% and negative predictive value of 96% for detection of long-term sequelae. What are the clinical implications of this work? Routine detailed ultrasound examination in pregnancy is not an appropriate screening tool for congenital CMV infection that leads to long-term sequelae. Awareness of the sonologist regarding congenital CMV and knowledge of the maternal serological status in the first trimester are key to the diagnostic performance of prenatal ultrasound.

Outcome of fetuses with congenital cytomegalovirus infection and normal ultrasound at diagnosis: systematic review and meta‐analysis

“…CMV infection is the most common fetal infection and is the leading cause of non-hereditary sensorineural hearing loss (SNHL) in high-income countries [44][45][46] . However, despite the clinical relevance of the infection, although maternal serological screening has been improved, it is currently offered in only a few countries, such as Germany and Italy 47 . Currently, parental counseling in pregnancies affected by congenital CMV infection is still based on observational studies that date back many years.…”

Renal Involvement in Congenital Cytomegalovirus Infection: A Systematic Review

“…In an Italian case series [31], hydronephrosis was described in only one out 154 (0.6%) fetuses with cCMV infections; the infant was later diagnosed with symptom-free cCMV infection. Of note, several series describing US findings in fetuses with cCMV infections were excluded from this systematic review, because they did not report kidney abnormalities at all (n = 73 [60] and n = 237 [61]).…”

Leaning towards Cytomegalovirus serological screening in pregnancy to prevent congenital infection: a cost‐effectiveness perspective

“…1 Despite these compelling figures, there has been no implementation of any organised prenatal screening programmes for congenital CMV and infected fetuses are mainly detected incidentally through routine ultrasound assessment in pregnancy. 6,7 Four main reasons are usually raised in opposition to universal CMV serological screening in pregnancy: (i) CMV serological screening is not applicable to non-primary CMV infections; (ii) one is not able to identify which women are likely to transmit CMV to their fetus; (iii) the prediction of postnatal disabilities in infected fetuses is impossible; and (iv) there is no effective treatment to limit maternal-fetal transmission and/or to reduce the likelihood and severity of disabilities in infected newborns. 8 Recent breakthroughs should be taken into account, however.…”