OC086: Antenatal assessment of fetal infection with cytomegalovirus

Abstract

Congenital cytomegalovirus (CMV) is a prevalent and potentially severe disease. The objective of this paper was to identify all ultrasound findings in fetuses infected with CMV. Retrospective analysis of all cases of congenital cytomegalovirus infections demonstrated by positive PCR in the amniotic fluid referred to three fetal medicine units, between 1997 and 2004. All third level ultrasound examination findings were collected. Estimated time of seroconversion and indication for amniocentesis were reviewed. 93 cases were amenable for analysis. 43 were detected by seroconversion, in which 20 (46%) showed ultrasound abnormalities. The other 50 patients were referred following the diagnosis of ultrasound abnormalities in the second or third trimester. The most frequent findings were Ventriculomegaly (27%), Hyperechogenic bowel (24%), IUGR (19%), Intracerebral hyperechogenic foci (19%), microcephaly (17%), Oligohydramnios (11%), hepatosplenomegaly (9%) and isolated ascitis (7%). Seroconversion in the first, second and third trimester presented US abnormalities in 56%, 44% and 25% of cases respectively. Amniotic fluid viral load (AFVL) was 2.4 million cp/ml [100cp/ml—40 million cp/ml]. Mean gestational age at amniocentesis was 25 [17–36] weeks. A correlation was found between AFVL and gestational age (Spearman Rank Test R = 0.4 p?0.0007), but not with the presence or severity of US features (Wilcoxon). Several ultrasound features are consistently present in fetal infection with cytomegalovirus. The earlier the seroconversion, the higher the incidence of US findings. AFVL does not contribute valuably to stablish the prognosis of the disease.