Prenatal diagnosis of fetal cytomegalovirus infection

Article Abstract:

The most frequent intrauterine infections are caused by cytomegalovirus. Symptomatic infection of the fetus most often follows primary (first-time) maternal infection, although it can also occur with reactivated maternal infections. Even though only 10 percent of infected fetuses have symptoms at birth, up to 30 percent die of late complications. Also long-term neurologic problems can later develop in asymptomatic infants. The course of intrauterine cytomegalovirus infections is unclear, and the reason why more than 60 percent of fetuses exposed to primary infection do not become infected is unknown, However, some fetuses are known to be irreversibly harmed before birth. Antiviral agents are now becoming available, and early prenatal diagnosis may allow treatment in utero. Besides virus culturing (isolating the virus from tissue and growing it in the laboratory), new techniques that detect viral DNA and RNA (genetic material) in human tissues have been used to diagnosis viral infections. The experience with prenatal diagnosis of cytomegalovirus infection in 12 fetuses is described. Primary infections occurred in seven of the pregnant women, all of whom had symptoms and antibodies against the virus, but had ultrasound findings that indicated a structurally normal fetus. One infection was diagnosed by culturing virus from amniotic fluid and fetal blood and by the elevated levels of GGTP (gamma-glutamyl transpeptidase), a liver enzyme, indicating liver damage. Five additional fetal infections were suspected because of abnormal ultrasound results such as dilation of ventricles (fluid-filled brain cavities), microcephaly (small skull size), or calcifications within the brain. In addition, fetal blood was tested for total levels of antibodies and antibodies against the virus. Subsequent isolation of virus from fetal tissues confirmed the findings. All of the six infected fetuses died. The study indicates that information from ultrasound, combined with data from amniocentesis and fetal blood sampling allows diagnosis of fetal cytomegalovirus infection. The prognosis of fetuses with normal ultrasound findings, but other signs of infection, is unclear and must await further research. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Fetal cytomegalovirus infection: a case report

Article Abstract:

The cytomegalovirus, a herpes-type virus, can pass from an infected mother to her developing fetus. It is the most common fetal infection occurring during pregnancy. Although many infants will have no symptoms at birth, between 5 and 10 percent will have severe neurological deficits, such as small head size and mental retardation. The long-term and milder neurological consequences of fetuses born without symptoms are not known. A 27-year-old obese women developed fever, fatigue and malaise during the 11th week of pregnancy. The patient had difficulty forming and expressing words. The symptoms ceased after five days, at which time a diagnosis of cytomegalovirus infection was confirmed. It was decided to test the fetus's umbilical cord blood to determine whether the cytomegalovirus had infected the fetus. The tests, which included viral culture, serological blood testing and the use of other indicators of infection, were positive for the virus and the pregnancy was terminated. Autopsy revealed a normal cytomegalovirus-infected fetus with evidence of an early or mild case of cytomegalic inclusion disease. It is not known whether neurological damage would have been present in the absence of clinical symptoms. More research is needed to study the value of prenatal diagnosis to predict future neurological events caused by a cytomegalovirus infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Infection, Fetus, Cytomegaloviruses, Cytomegalovirus, Cytomegalic inclusion disease

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First-trimester multifetal pregnancy reduction: acute and persistant psychologic reactions

Article Abstract:

Women who had first-trimester multifetal pregnancy reduction generally found it psychologically stressful but recovered. A smaller subgroup tended to experience long-lasting feelings of sadness and guilt. Ninety-one women who underwent multifetal reduction after conceiving triplets to nonituplets via in vitro fertilization agreed to a telephone interview one to three years after the procedure. More than 65% found the procedure emotionally painful, stressful, and frightening. Seventy percent of the women mourned the lost fetuses, but few mourned longer than one month. Moderately severe feelings of sadness or guilt persisted for 20% of the group, especially among younger, more religious women, who had viewed the embryos more frequently on ultrasound. However, 93% would make the same decision again. It is thought that relief and bonding to the remaining fetuses served to buffer negative feelings. Additional psychological support may be of benefit, especially among women fitting the profile of the subgroup that was more likely to experience prolonged or severe reaction.

Psychological aspects, Complications and side effects, Pregnant women, Abortion, Pregnancy, Multiple, Multiple pregnancy, Loss (Psychology)

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