Acute Perinatal Infection and the Evidenced-Based Risk of Intrauterine Diagnostic Testing: A Structured Review

Abstract

Background: The prevalence of perinatal infection from maternal exposure is increasing. The prevalence of acute maternal infections identifies cytomegalovirus, parvovirus B19, toxoplasmosis, and varicella as the most common organisms and in the order of frequency. Maternal informed consent and understanding is required before intrauterine testing for fetal infectious and possible genetic risk assessment. Methods: This structured review of the reproductive published literature focuses on the risks of amniocentesis and cordocentesis diagnostic procedure-related fetal loss rates and fetal vertical transmission (VT) rates from published infected pregnant cohorts. Results: The total postprocedure fetal loss rate for diagnostic amniocentesis procedures, in limited infectious cohorts, is 1.5% and does not appear to be increased compared to "noninfected" amniocentesis cohorts using an estimated background spontaneous fetal loss rate (no procedure) of 0.65%. The "pooled" unintended fetal loss rate is from small infected population cohorts, but can be used for counseling purposes. Postcordocentesis fetal loss risk, in an infected cohort, is not possible to estimate due to limited data. The "biological spontaneous fetal loss rate" risk with a perinatal infection (positive or negative fetal anomalies) and no diagnostic procedure before 20 weeks of gestation is reviewed. The risk of VT in acute infection cohorts as a result of the intra-amniotic diagnostic procedure is not found to be increased. Conclusion: The unintended "fetal loss" rate after amniocentesis for perinatal infected cohorts is similar to that of noninfected cohorts, but the estimate is based on limited infected cohorts. There was no procedure-based risk of fetal VT in the infected cohorts, but identification of postprocedure maternal bleeding into the amniotic cavity increases the potential risk. Maternal knowledge translation and an informed consent process with risk-benefit maternal/fetal risk counseling are required prior to any diagnostic amniocentesis procedure.

An Overview of Cytomegalovirus Infection in Pregnancy

“…The confirmation of fetal involvement requires the direct detection of CMV in an amniotic fluid culture. Together with the evaluation of blood parameters acquired through cordocentesis, this method has the highest prediction ability, but both methods are avoided because of the associated procedure risks [ 46 ].…”

An Overview of Cytomegalovirus Infection in Pregnancy

“…The confirmation of fetal involvement requires the direct detection of CMV in an amniotic fluid culture. Together with the evaluation of blood parameters acquired through cordocentesis, this method has the highest prediction ability, but both methods are avoided because of the associated procedure risks [ 46 ].…”

Parvovirus B19 in Pregnancy—Do We Screen for Fifth Disease or Not?

“…Another notable feature is peripheral polyarthropathy, mainly affecting the knees or hand joints; in pregnant patients, this may be the sole manifestation, occurring in up to 50% of cases, and may persist for several weeks to months. The onset of arthritis aligns with IgM antibody detection, typically 10–12 days post-primary infection, which remains positive for up to 3 months, while IgG antibodies persist for life [4,5,6,7,8,9,10].…”

“…In assessing the implications of antibody determination specifically when anemia with reticulocytopenia is present, several factors warrant careful consideration. These include the cost-effectiveness of testing, the potential benefits of alternative screening strategies, and the potential consequences of delaying antibody testing until these hematologic manifestations are evident [1,4,10,15].…”

What can fetal neurosonography reveal about the future of an unborn child?

“…In the event of abnormal findings, it is the responsibility of the attending physician to advise the parents. This often includes recommending MRI and genetic testing in order to increase diagnostic certainty and, if necessary, offer appropriate treatment 12 13 18 19 .…”

“…Dazu gehört häufig auch die Empfehlung einer MRT-Bildgebung bzw. einer genetischen Untersuchung, um die Diagnose-Sicherheit zu erhöhen und bei Bedarf eine geeignete Behandlung anzubieten 12 13 18 19 .…”

An Overview of Cytomegalovirus Infection in Pregnancy

“…The confirmation of fetal involvement requires the direct detection of CMV in an amniotic fluid culture. Together with the evaluation of blood parameters acquired through cordocentesis, this method has the highest prediction ability, but both methods are avoided because of the associated procedure risks [ 46 ].…”

Parvovirus B19 in Pregnancy—Do We Screen for Fifth Disease or Not?

“…Another notable feature is peripheral polyarthropathy, mainly affecting the knees or hand joints; in pregnant patients, this may be the sole manifestation, occurring in up to 50% of cases, and may persist for several weeks to months. The onset of arthritis aligns with IgM antibody detection, typically 10–12 days post-primary infection, which remains positive for up to 3 months, while IgG antibodies persist for life [4,5,6,7,8,9,10].…”

“…In assessing the implications of antibody determination specifically when anemia with reticulocytopenia is present, several factors warrant careful consideration. These include the cost-effectiveness of testing, the potential benefits of alternative screening strategies, and the potential consequences of delaying antibody testing until these hematologic manifestations are evident [1,4,10,15].…”

What can fetal neurosonography reveal about the future of an unborn child?

“…In the event of abnormal findings, it is the responsibility of the attending physician to advise the parents. This often includes recommending MRI and genetic testing in order to increase diagnostic certainty and, if necessary, offer appropriate treatment 12 13 18 19 .…”

“…Dazu gehört häufig auch die Empfehlung einer MRT-Bildgebung bzw. einer genetischen Untersuchung, um die Diagnose-Sicherheit zu erhöhen und bei Bedarf eine geeignete Behandlung anzubieten 12 13 18 19 .…”

An Overview of Cytomegalovirus Infection in Pregnancy

“…The confirmation of fetal involvement requires the direct detection of CMV in an amniotic fluid culture. Together with the evaluation of blood parameters acquired through cordocentesis, this method has the highest prediction ability, but both methods are avoided because of the associated procedure risks [ 46 ].…”

Parvovirus B19 in Pregnancy—Do We Screen for Fifth Disease or Not?

“…Another notable feature is peripheral polyarthropathy, mainly affecting the knees or hand joints; in pregnant patients, this may be the sole manifestation, occurring in up to 50% of cases, and may persist for several weeks to months. The onset of arthritis aligns with IgM antibody detection, typically 10–12 days post-primary infection, which remains positive for up to 3 months, while IgG antibodies persist for life [4,5,6,7,8,9,10].…”

“…In assessing the implications of antibody determination specifically when anemia with reticulocytopenia is present, several factors warrant careful consideration. These include the cost-effectiveness of testing, the potential benefits of alternative screening strategies, and the potential consequences of delaying antibody testing until these hematologic manifestations are evident [1,4,10,15].…”

What can fetal neurosonography reveal about the future of an unborn child?

“…In the event of abnormal findings, it is the responsibility of the attending physician to advise the parents. This often includes recommending MRI and genetic testing in order to increase diagnostic certainty and, if necessary, offer appropriate treatment 12 13 18 19 .…”

“…Dazu gehört häufig auch die Empfehlung einer MRT-Bildgebung bzw. einer genetischen Untersuchung, um die Diagnose-Sicherheit zu erhöhen und bei Bedarf eine geeignete Behandlung anzubieten 12 13 18 19 .…”