Abstract

CYTOMEGALOVIRUS. CORRELATION WITH AMNIOTIC FLUID VIRAL LOAD AND OUTCOME MASAMI YAMAMOTO, FRANCOIS JACQUEMARD, OLIVIER PICONE, JEANMARC COSTA, YVES VILLE, CHI Poissy-St Germain, Poissy, France, Institute de Puericulture de Paris, Service de Medicine Foetale, Paris, France, Universite Paris Ouest SQY-V CHI Poissy St Germain en Laye, Obstetrics and Gynecology Service, Poissy, France, American Hospital of Paris, Service de Biologie Moleculaire Marcel Dassault, Neuilly sur Seine, France OBJECTIVE: To identify all ultrasound findings in fetuses infected with CMV and its relation with amniotic fluid viral load and outcome. STUDY DESIGN: All cases of fetal cytomegalovirus infection from maternal primary infection and diagnosed by viral genome amplification by PCR in amniotic fluid, between 1997-2004 were reviewed for ultrasound features, time of maternal seroconversion and amniotic fluid viral load. RESULTS: 70 of 93 infected fetuses at 25 [17-36] weeks had ultrasound features of infection and 46% of them showed more than one abnormality. The most frequent findings were ventriculomegaly (27%), hyperechogenic bowel (24%), growth restriction (19%), intracerebral hyperechogenicity (19%), microcephaly (17%), oligohydramnios (11%), hepatosplenomegaly (9%) and isolated ascitis (7%). Amniotic fluid viral load (AFVL) was 2.4 ! 107 [102-4 ! 107] cp/mL increased with gestational age (R = 0.4, P = 7 ! 10-4). Termination of pregnancy was performed for infection in 63 (67%) of the cases as confirmed by postmortem examination. There was 1 neonatal death in a severe congenital infection with preterm delivery at 32 weeks and 1 case of severe neurological impairment. Fetuses without US features presented a normal follow-up. There was no correlation between amniotic fluid viral load and the presence or severity of ultrasound abnormalities nor with outcome. Maternal seroconversion in the first, second and third trimester presented US abnormalities in 56%, 44% and 25% of cases respectively. Ultrasound features were progressive with gestation in at least 46% of cases. The virus is excreted by fetal urine and accumulates in the amniotic fluid irrespective of the severity of the fetal infection. CONCLUSION: The earlier the seroconversion, the higher the incidence of US findings. AFVL does not contribute valuably to establish the prognosis of the disease. The absence of ultrasound findings on targeted serial ultrasound examination is reassuring.

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