Cytomegalovirus fetal infection: prenatal diagnosis

Article Abstract:

Infection with cytomegalovirus (CMV), a member of the herpesvirus family, is the most common fetal infection, and the risk of CMV transmission from a mother with a primary (first-time) infection to the fetus can be as great as 40 percent. Ten percent of infants born in such cases have signs of infection; as many as 30 percent of newborns with CMV die and many survivors will face complications and handicaps. In spite of the importance of the disease, little is known concerning its prenatal diagnosis. Results are reported here from a study of prenatal diagnosis of CMV in 15 pregnant women shown to have primary cytomegalovirus infection. The patients underwent ultrasound examination, amniocentesis (in which a small amount of the fluid in which the baby floats is removed and analyzed), and fetal blood sampling. Cultures were grown from amniotic fluid and fetal blood to determine the presence of CMV. Other tests were also carried out, including liver function tests, blood cell counts and platelet counts. Results showed that eight fetuses had no signs of infection, while eight were found to be infected (one was a twin pregnancy). Although no signs of virus were identified in fetal blood, some tests showed other nonspecific indicators of infection. Three pregnancies were terminated because of these signs of infection; in these cases, fetal tissue tested positive for cytomegalovirus. Four pregnancies continued to term because the abnormalities were only slight; three infants had subclinical (very mild) infections and the fourth had hearing loss in both ears. The twin pregnancy included one infected and one noninfected twin; the infected fetus died soon after birth of disease related to CMV, while the other twin appeared to be healthy. These results show that prenatal diagnosis of cytomegalovirus is possible and reliable; amniocentesis correctly identified all cases of fetal CMV infection. When ultrasound findings are normal and laboratory test results only slightly abnormal, the pregnancy should probably proceed with close follow-up after birth. Ultrasound abnormalities were seen in the fetuses with more severe CMV disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Infection, Complications and side effects, Fetus, Disease transmission, Cytomegalovirus infections, Prenatal diagnosis, Cytomegaloviruses, Cytomegalovirus

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Markedly elevated maternal serum alpha-fetoprotein associated with a normal fetus and choriocarcinoma of the placenta

Article Abstract:

Maternal serum alpha-fetoprotein (MSAFP) is measured in the mother's blood to test for fetal abnormalities during pregnancy. Elevations of MSAFP may indicate a range of placental, fetal, and maternal disorders. The case is described of a pregnant woman with very high MSAFP levels (as much as 140 times the median normal levels) but no apparent fetal abnormalities. Numerous tests during pregnancy failed to reveal the cause of the MSAFP elevations. A healthy boy baby was delivered, but examination of the placenta revealed choriocarcinoma, a very malignant type of cancer often located at the site of implantation in the uterus. The patient also had a metastasis (cancer spread) in one lung. Sixteen days after delivery, a total hysterectomy (removal of the female reproductive organs) was performed, and the patient subsequently underwent several courses of chemotherapy. She remained well after the last of these treatments. Known causes of elevations in MSAFP are discussed. This case represents the highest reported MSAFP levels, and the first case of choriocarcinoma with an otherwise normal placenta associated with the delivery of a normal fetus. The results indicate that the diagnosis of choriocarcinoma should be considered when MSAFP is elevated, and that the placenta should be evaluated when no other explanation for the elevation is found. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Case studies, Measurement, Physiological aspects, Uterine cancer, Alpha fetoproteins, Choriocarcinoma

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