Prenatal diagnosis of congenital cytomegalovirus infection: two decades later

Article Abstract:

Between 30,000 and 40,000 infants are born infected with cytomegalovirus (CMV) in the United States each year. The epidemiology, prenatal diagnosis, prevention and treatment of fetal CMV infection are reviewed. CMV, a type of human herpesvirus, is transmitted to pregnant women by exposure to body excretions or by intimate sexual contact. Women with the greatest risk of CMV infection are those who are less than 25 years old or who have young children at home. Many women who are infected will not have symptoms, but some will have a syndrome similar to mononucleosis, with fever and enlargement of the spleen. During the viremic phase, when the virus multiplies, it may infect the fetus in a pregnant woman; CMV infection causes the most adverse effects on the fetus in the first half of pregnancy. A CMV-infected infant may appear to be normal at birth, but may later develop nerve-related disorders. The various mechanisms by which a fetus may become infected with CMV are described. CMV infection can be diagnosed by testing the amniotic fluid surrounding the fetus, fluid from the umbilical cord, blood from the fetus and mother, and urine of the infant at birth. Culturing of amniotic fluid should be performed if a woman is suspected of being infected with CMV or if fetal abnormalities in growth and development are detected by ultrasonography, in which sound waves are used to visualize the fetus. The antiviral agent ganciclovir was shown to be effective against CMV-induced retinitis, inflammation of the retina, the inner lining of the eye. Treatment of fetal CMV infection must be started before birth to prevent or reduce the adverse effects of the disease on fetal growth and development. Thus, congenital CMV infection is a major health problem which has not received adequate attention. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Complications and side effects, Pregnant women, Birth defects

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Prenatal diagnosis of congenital cytomegalovirus infection by virus isolation from amniotic fluid

Article Abstract:

Cytomegalovirus (CMV) is one of the herpes viruses and is the most common cause of congenital infection. CMV can be associated with serious complications when it occurs during pregnancy. Several reports have indicated that CMV can be grown in the laboratory from samples of amniotic fluid, thus aiding diagnosis of a CMV infection, but this technique is somewhat controversial. Two additional cases of prenatal diagnosis of CMV infection are described in this report. In the first case, a 17-year-old patient was at 37 weeks' gestation (normal delivery is at 40 weeks) when she developed malaise, lower abdominal discomfort, diarrhea, and fever. Ultrasound imaging showed accumulation of excessive amniotic fluid, collection of urine in the fetal kidney, and possible fetal growth retardation. Amniocentesis was done to sample the amniotic fluid and discriminate between infection and inflammation of the amniotic sac. CMV infection was diagnosed from culture of the fluid, and labor was induced to expedite treatment. The infant was healthy and did not have typical signs of CMV infection. However, within one week, tests showed CMV infection, possibly in the brain and nervous system. The second patient was a 25-year-old woman who was tested for CMV after routine ultrasonography showed apparent fluid accumulation in the fetal heart or lungs. CMV infection was diagnosed with the help of amniotic fluid sampling. The fluid accumulation resolved quickly thereafter, and the newborn was born at normal term and was healthy. The report suggests that the risk of amniocentesis is justified in pregnant women with symptoms strongly suggestive of CMV infection or when ultrasonography indicates a possible fetal infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnancy, Complications of, Pregnancy complications, Amniocentesis

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Diagnosis of fetal infection in the patient with an ultrasonographically detected abnormality but a negative clinical history

Article Abstract:

Diagnosis of suspected viral and parasitic infections of the fetus should be done prenatally, not after delivery. Fetal infections are frequently overlooked as potential causes of abnormalities detected by ultrasound. Even if fetal infection is suspected, the usual approach is to wait until delivery for diagnosis and treatment. Prenatal diagnosis and treatment, however, reduce the risks of fetal death and the spread of infection to other newborn infants in the maternity unit. Furthermore, infections left untreated may be more difficult to cure following delivery. Fetal infection can be diagnosed through several means: blood tests, electron microscopy, culturing of amniotic fluid, DNA analysis and liver enzyme analysis.

Usage, Abnormalities, Prenatal diagnosis

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