P09.01: Correlations between ultrasound and fetal haematological parameters in 67 fetuses infected with cytomegalovirus (CMV)

Abstract

To study pronostic factors in fetal blood of fetuses infected by CMV. 69 cases of fetal infections diagnosed by amniocentesis (presence of DNA CMV or positive culture). Prognostic factors that were evaluated against ultrasound (US) and MRI of the fetal brain included: Haematological parameters: presence of CMV DNA, trend in fetal blood viral load, platelet count, biochemical markers including Gamma Glutamyl transferase (GGT) and liver enzymes. When termination of pregnancy (TOP) was performed, all fetuses were examined to assess the severity of fetal infection. Follow up of infected neonates was up to 96 months. Good outcome (GO) was achieved in 30 cases (42%), poor outcome (PO) in 39 cases (58%), including 33 TOP, 2 intra uterine fetal deaths, 1 unilateral deafness, 3 mental retardations caused by severe brain anomaly. US parameters were normal in 30 cases (44%), abnormal in 37 (66%). Good outcome was observed in 23 cases/30 without abnormal US signs, although in 5 cases presence of abnormal biological parameters led toTOP. Autopsy confirmed severe disseminated infection. Sensitivity (Sens) of abnormal US parameters to predict a poor fetal outcome was 82%, with positive predictive value (PPV) of 86% and specificity (Spec) of 82%. Sens of abnormal biological parameters to predict a poor fetal outcome was 94% with PPV of 94.8%. In case of absent abnormal ultrasonographic signs, or minor signs, Sens of normal biological parameters was 91%, PPV 95%, Spec 85%. The most effective biological tests useful for appropriate evaluation of fetal prognosis was the platelet count (98% of normal results in case of GO versus 38% in case of PO, p < 0.001), followed by normal fetal liver tests (88% of normal liver tests in case of GO, versus 30% in PO, p < 0.01). A combination of ultrasonographic and biological parameters allows to identify more accurately than ultrasound alone the fetuses with good or adverse outcome.