P22.09: Immunoglobulin fetal therapy in prenatal infection with Cytomegalovirus. Report of three cases

Abstract

Cytomegalovirus (CMV) is a frequent infection that cause miscellaneous ultrasound findings and fetal well-being compromise. Sonographic markers, maternal serum (IgG, IgM, IgGavidity) and PCR are diagnostic. Treatment is antiviral medication or hypergammaglobulin and fetal support. We report three cases of prenatal CMV treated with gammaglobulin (total dose was 150 mg/kg each case) and fetal support. First patient sonogram showed polihydramnios, placentosis, ventriculomegaly, periventricular and liver calcifications, hydrops, hepatosplenomegaly and hyperechogenic spleen and IUGR with normal Doppler. Fetal treatment with globulin was given as described and hydrops and ventriculomegaly were solved. High resistance in umbilical artery (UA) and a week later brain sparing were observed and underwent to C-section. A 34 wks female was delivered to NICU, without sequelae in follow up. Second case was a 26wo pregnant woman with polihydramnios, fetal pleural effusion with mediastinal shift, and hydrops at ultrasound. Doppler showed high resistance in UA with high impedance in DV. Fetal therapy with globulin was ongoing and the fetus underwent to pleuroamniotic shunt. Mediastinal shift and hydrops were solved. Patient underwent to EXIT procedure. A 37 wks male was delivered. Neurological follow up was satisfactory. In last case, at 27wo pregnancy sonogram showed ventriculomegaly, brain and hepatic calcifications, hepatoesplenomegaly and ascites. IUGR with normal UA was seen. MCA-PSV was over 1.55 MoM and fetal anemia was diagnosed, patient underwent to globulin therapy and intrauterine transfusion was performed twice. Doppler showed central vasodilatation pattern at 31 wks and C-section was performed. Baby went to NICU. After critical condition, neurological follow up show left deafness. Congenital CMV is a common condition in underdeveloped countries. Fetal therapy consists on gammaglobulin as medical and invasive therapy support according with particular conditions.