A Rare Case of Congenital Cytomegalovirus Infection in Pregnancy

Abstract

Mrs. SC, 30-years old in her third pregnancy, had two previous pregnancies 7 and 2 years ago which ended in uncomplicated term vaginal deliveries. She was booked for antenatal care at about 13 weeks. The mother’s blood group was A Rhesus positive. She had triple test for trisomy 21 and neural tube defects at 16 weeks gestation and was found to be low risk for both. At 30 weeks gestation she reported reduced fetal movements. The Cardiotocography (CTG) (Fig. 1) showed diminished variability with a few shallow decelerations suggesting fetal hypoxia. Considering the suboptimal CTG an ultrasound scan was performed which showed significant ventriculomegaly (Fig. 2), pericardial effusion, ascites, splenomegaly and oligohydramnios. The couple was counselled regarding significant risk of handicap. Since the underlying cause was uncertain at that point, she had further investigations for hydrops including maternal serology for viral screening and fetal cordocentesis which subsequently confirmed maternal and fetal Cytomegalovirus (CMV) infection (Table 1). She did not want any active intervention. A couple of days later the mother reported no fetal movements and an ultrasound scan confirmed intrauterine fetal death. A stillborn female baby (Fig. 3) weighing 1,455 g was delivered 2 days later following induction of labour. In the post-mortem report, it was commented that the lung showed numerous enlarged cells with nuclear and cytoplasmic inclusions characteristic of active CMV infection. The macroscopic feature of hepatosplenomegaly was consistent with this finding and that no other internal anatomical abnormalities were found.