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First-line noninvasive management of cytomegalovirus primary infection in pregnancy

  • Marie Denef EMAIL logo , Laure Noel , Gaëlle Bruck , Justine Gudelj , Malek Tebache , Renaud Viellevoye , Michelle Nisolle and Frédéric Chantraine
Published/Copyright: December 20, 2021
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 50 Issue 3

Abstract

Objectives

To introduce a first-line noninvasive antenatal management of maternal cytomegalovirus (CMV) primary infection based on ultrasound (US) and magnetic resonance imaging (MRI). Amniocentesis (AC) is used as a second-line tool in cases of abnormalities compatible with fetal CMV infection on US and/or MRI screening.

Methods

Between January 2011 and October 2018, pregnant women referred with a CMV primary infection on antibody screening were followed up by monthly US scans and a brain MRI at approximately 32 weeks. In cases with US and/or MRI abnormalities compatible with congenital CMV infection, AC was performed to confirm the diagnosis.

Results

Ninety pregnant women with a primary CMV infection were included (89 singleton and one twin pregnancy). The first-line screening by US and/or MRI was normal for 72 of 91 fetuses (79%). At birth, 19 of these 72 neonates (26%) had a positive urine sample for CMV but were asymptomatic. US and/or MRI abnormalities were identified in 19 fetuses (21%). AC confirmed a fetal CMV infection in 16 fetuses (84%); 12 pregnancies were terminated, and four were continued, with three symptomatic neonates at birth and one poor neurodevelopmental outcome at postnatal follow-up.

Conclusions

First-line noninvasive management of maternal CMV primary infection based on serial US scans and brain MRI can be offered to identify fetuses with severe symptomatic congenital CMV infection and reduce the number of ACs without compromising the fetal outcome.

Keywords: amniocentesis (AC); cytomegalovirus(CMV); magnetic resonance imaging (MRI); pregnancy; primary infection; ultrasound
Corresponding author: Marie Denef, MD, Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Liège, site CHR Citadelle, Boulevard du 12ième de Ligne, 4000 Liege, Belgique, Phone: 00324 321 85 43, E-mail:

  1. Research funding: None declared.

  2. Author contributions: Conceptualization: MD, LN, FC; Methodology: MD, LN, FC; Data collection: MD, LN, GB, JG; Data interpretation: MD, LN, MT, RV, FC; Manuscript draft: MD, LN; Manuscript review & editing: MD, LN, MT, RV, MN, FC. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: The authors state no conflicts of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Research involving human subjects complied with all relevant national regulations and institutional policies and was in accordance with the tenets of the Helsinki Declaration (as revised in 2013). Approved by the authors’ Institutional Review Board or equivalent committee (JL/bl/1870 – B4122020000011).

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2021-0384).

Received: 2021-08-01
Accepted: 2021-11-14
Published Online: 2021-12-20
Published in Print: 2022-03-28

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

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  2. Corner of Academy
  3. Cost of providing cell-free DNA screening for Down syndrome in Finland using different strategies
  4. Adverse perinatal outcomes following the prenatal diagnosis of isolated single umbilical artery in singleton pregnancies: a systematic review and meta-analysis
  5. Original Articles – Obstetrics
  6. Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls
  7. The postpartum period during the COVID-19 pandemic: investigating Turkish women’s postpartum support and postpartum-specific anxiety
  8. First-line noninvasive management of cytomegalovirus primary infection in pregnancy
  9. Ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders
  10. Improved management of placenta accreta spectrum disorders: experience from a single institution
  11. A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  12. The impact of preimplantation genetic testing for aneuploidy on prenatal screening
  13. Original Articles – Fetus
  14. Myocardial deformation analysis in late-onset small-for-gestational-age and growth-restricted fetuses using two-dimensional speckle tracking echocardiography: a prospective cohort study
  15. HDlive Flow Silhouette with spatiotemporal image correlation for assessment of fetal cardiac structures at 12 to 14 + 6 weeks of gestation
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  17. Original Articles – Neonates
  18. Pulmonary hypertension in infants with bronchopulmonary dysplasia: risk factors, mortality and duration of hospitalisation
  19. Outcomes from birth to 6 months of publicly insured infants born to mothers with severe acute respiratory syndrome coronavirus 2 infection in the United States
  20. Placental findings are not associated with neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy – an 11-year single-center experience
  21. High frequency band limits in spectral analysis of heart rate variability in preterm infants
  22. Bacterial DNA detection in very preterm infants assessed for risk of early onset sepsis
  23. Short Communication
  24. Healthcare workers’ attitudes about vaccination of pregnant women and those wishing to become pregnant
  25. Letter to the Editors
  26. Comment on Abdel Wahab et al.: A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  27. Re: Comment on Abdel Wahab et al.: A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  28. SARS-CoV-2 behavior, through the eyes of a perinatologist?
  29. Re: SARS-CoV-2 behavior, through the eyes of a perinatologist?
https://doi.org/10.1515/jpm-2021-0384
Keywords for this article
amniocentesis (AC); cytomegalovirus(CMV); magnetic resonance imaging (MRI); pregnancy; primary infection; ultrasound

Articles in the same Issue

  1. Frontmatter
  2. Corner of Academy
  3. Cost of providing cell-free DNA screening for Down syndrome in Finland using different strategies
  4. Adverse perinatal outcomes following the prenatal diagnosis of isolated single umbilical artery in singleton pregnancies: a systematic review and meta-analysis
  5. Original Articles – Obstetrics
  6. Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls
  7. The postpartum period during the COVID-19 pandemic: investigating Turkish women’s postpartum support and postpartum-specific anxiety
  8. First-line noninvasive management of cytomegalovirus primary infection in pregnancy
  9. Ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders
  10. Improved management of placenta accreta spectrum disorders: experience from a single institution
  11. A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  12. The impact of preimplantation genetic testing for aneuploidy on prenatal screening
  13. Original Articles – Fetus
  14. Myocardial deformation analysis in late-onset small-for-gestational-age and growth-restricted fetuses using two-dimensional speckle tracking echocardiography: a prospective cohort study
  15. HDlive Flow Silhouette with spatiotemporal image correlation for assessment of fetal cardiac structures at 12 to 14 + 6 weeks of gestation
  16. Umbilical artery pulsatility index and half-peak systolic velocity in second- and third-trimester fetuses with trisomy 18 and 13
  17. Original Articles – Neonates
  18. Pulmonary hypertension in infants with bronchopulmonary dysplasia: risk factors, mortality and duration of hospitalisation
  19. Outcomes from birth to 6 months of publicly insured infants born to mothers with severe acute respiratory syndrome coronavirus 2 infection in the United States
  20. Placental findings are not associated with neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy – an 11-year single-center experience
  21. High frequency band limits in spectral analysis of heart rate variability in preterm infants
  22. Bacterial DNA detection in very preterm infants assessed for risk of early onset sepsis
  23. Short Communication
  24. Healthcare workers’ attitudes about vaccination of pregnant women and those wishing to become pregnant
  25. Letter to the Editors
  26. Comment on Abdel Wahab et al.: A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  27. Re: Comment on Abdel Wahab et al.: A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  28. SARS-CoV-2 behavior, through the eyes of a perinatologist?
  29. Re: SARS-CoV-2 behavior, through the eyes of a perinatologist?
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