Revisiting short‐ and long‐term outcome after fetal first‐trimester primary cytomegalovirus infection in relation to prenatal imaging findings

Lipitz, Shlomo; Miller, T. Elkan; Yinon, Yoav; Weissbach, Tal; DeCastro, Helbert; Hoffman, Chen; Katorza, E.; Weisz, Boaz

doi:10.1002/uog.21946

Cited by 20 publications

(24 citation statements)

References 30 publications

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“…The role of MRI in the management of CMV is still to be defined, especially in settings in which MRI is not readily available. As suggested by Lipitz et al 1 ,. and in view of studies which demonstrate that the gestational age at the time of maternal infection is a major prognostic factor 4,5 , MRI may be limited to fetuses infected during the first trimester of pregnancy.…”

mentioning

confidence: 79%

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Role of magnetic resonance imaging in management of congenital cytomegalovirus infection

Picone

Mandelbrot

2020

Ultrasound in Obstet & Gyne

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confidence: 79%

“…We congratulate Lipitz et al . on their very interesting paper on the prognosis of fetal cytomegalovirus (CMV) infection in the first trimester of pregnancy 1 . It is the largest series on this topic, and the information is useful for management of congenital CMV infection.…”

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confidence: 99%

Role of magnetic resonance imaging in management of congenital cytomegalovirus infection

Picone

Mandelbrot

2020

Ultrasound in Obstet & Gyne

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“…The majority of diagnostic procedures are limited to amniocentesis and, in selected infections such as CMV, cordocentesis (Table 3) [48][49][50][51][52][53][54][55][56]. The total fetal risk related to amniocentesis in infected cohorts is estimated at 1.5%.…”

Section: Discussionmentioning

confidence: 99%

“…The possibility of an increased preterm birth mechanism associated with intrauterine viral infection in the late second and third trimester alone has limited data to support this perinatal risk [19,46,47]. Table 3 summarizes the published literature for maternal infection cohorts and the outcomes for unintended fetal loss and evaluations to determine the possibility of fetal VT [48][49][50][51][52][53][54][55][56]. The "pooled" procedure-related fetal loss risk estimate for infectious diagnostic amniocentesis procedures is estimated at 1.5% (18/1,187) -0.8% from varicella (1/127), 0% from HCMV (0/458), and 2.8% from toxoplasmosis (17/602).…”

Section: Questionmentioning

confidence: 99%

“…Prenatal diagnostic procedures in infected maternal pregnant cohorts[48][49][50][51][52][53][54][55][56] Reference Infection cohort Study, time period, location Unintended pregnancy loss and VT summary Weisz et al [48], 2011 varicella retrospective study (2001-2007), Israel AC in 19/20 cases at a mean of 22.2 ± 1.7 weeks with a mean infection age of 11 ± 3.5 weeks; no postprocedural losses reported; no VT reported Mouly et al [49], 1997 varicella prospective cohort, 1989-1994, France; congenital varicella 2.8% (3/107); postnatal varicella zoster infection 3.8% (3/78) AC 107; FBS 82; procedures at 21-26 weeks of gestation; AC with positive viral AF PCR was identified in 9/107 (8.4%) with maternal infection at <24 weeks; single IUD after AC (negative prenatal testing); no procedure-related VT STOP, surgical termination of pregnancy; TOP, termination of pregnancy; US, ultrasound; VT, vertical transmission.…”

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confidence: 99%

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

Wilson

2020

Fetal Diagn Ther

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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.

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

Leruez‐Ville

Ren

Magny

et al. 2021

Ultrasound in Obstet & Gyne

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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.

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Revisiting short‐ and long‐term outcome after fetal first‐trimester primary cytomegalovirus infection in relation to prenatal imaging findings

Cited by 20 publications

References 30 publications

Role of magnetic resonance imaging in management of congenital cytomegalovirus infection

Role of magnetic resonance imaging in management of congenital cytomegalovirus infection

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

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

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