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Refining the prognosis of fetuses infected with Cytomegalovirus in the first trimester of pregnancy by serial prenatal assessment: a single-centre retrospective study.
Faure-Bardon, V; Millischer, A-E; Deloison, B; Sonigo, P; Grévent, D; Salomon, L; Stirnemann, J; Nicloux, M; Magny, J-F; Leruez-Ville, M; Ville, Y.
Afiliação
  • Faure-Bardon V; EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.
  • Millischer AE; Maternity, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France.
  • Deloison B; EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.
  • Sonigo P; Radiology, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France.
  • Grévent D; EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.
  • Salomon L; Maternity, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France.
  • Stirnemann J; EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.
  • Nicloux M; Radiology, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France.
  • Magny JF; EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.
  • Leruez-Ville M; Radiology, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France.
  • Ville Y; EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.
BJOG ; 127(3): 355-362, 2020 02.
Article em En | MEDLINE | ID: mdl-31505103
OBJECTIVE: To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection <14 weeks of gestation, at different time points of pregnancy: the end of the second trimester; following prenatal magnetic resonance imaging (MRI) at 32 weeks of gestation; and using all ultrasound scans performed in the third trimester (US3rdT). DESIGN: A retrospective study. SETTING: Reference fetal medicine unit. POPULATION: Sixty-two fetuses infected <14 weeks of gestation. METHODS: We defined second-trimester assessment (STA) as the combination of ultrasound findings <28 weeks of gestation and fetal platelet count at cordocentesis. Three groups were defined: normal, extracerebral, and cerebral STA. MAIN OUTCOME MEASURES: For each group, the PV of STA alone, STA + MRI, and STA + US3rdT were assessed retrospectively. Outcome at birth and at follow-up were reported. RESULTS: The STA was normal, and with extracerebral and cerebral features, in 43.5, 42.0, and 14.5%, respectively. The negative PV of normal STA and MRI for moderate to severe sequelae was 100%. The residual risk was unilateral hearing loss in 16.7% of cases. Of pregnancies with cerebral STA, 44% were terminated. Following extracerebral STA, 48% of neonates were symptomatic and 30% had moderate to severe sequelae. In those cases, the positive and negative PV of MRI for sequelae were 33 and 73%, respectively. STA + US3rdT had a lower negative PV than MRI for symptoms at birth and for moderate to severe sequelae. Any false-positive findings at MRI were mostly the result of hypersignals of white matter. CONCLUSIONS: Serial assessment in the second and third trimesters by ultrasound and MRI is necessary to predict the risk of sequelae occurring in 35% of pregnancies following fetal infection in the first trimester of pregnancy. TWEETABLE ABSTRACT: Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Infecciosas na Gravidez / Encéfalo / Imageamento por Ressonância Magnética / Ultrassonografia Pré-Natal / Infecções por Citomegalovirus / Citomegalovirus / Doenças Fetais / Polimicrogiria Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Infant / Male / Newborn / Pregnancy País/Região como assunto: Europa Idioma: En Revista: BJOG Assunto da revista: GINECOLOGIA / OBSTETRICIA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: França

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Infecciosas na Gravidez / Encéfalo / Imageamento por Ressonância Magnética / Ultrassonografia Pré-Natal / Infecções por Citomegalovirus / Citomegalovirus / Doenças Fetais / Polimicrogiria Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Infant / Male / Newborn / Pregnancy País/Região como assunto: Europa Idioma: En Revista: BJOG Assunto da revista: GINECOLOGIA / OBSTETRICIA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: França