Prenatal ultrasound findings in 93 cases of fetal infection with cytomegalovirus. Correlation with amniotic fluid viral load and outcome

An understanding of the pathogenesis of congenital cytomegalovirus (CMV) infections is hampered by the fact that the majority of adult infections are subclinical. This prevents documentation of the time of fetal infection. In the instance described, a 17-year-old pregnant female developed cytomegalovirus mononucleosis during her first trimester. CMV was recovered from her convalescent urine at 12 weeks' gestation and from amniotic fluid at 21 weeks' gestation. Following a therapeutic abortion at 22 weeks' gestation, CMV was recovered from multiple fetal organs. Cord serum contained 14 mg/100 ml IgM which is elevated for a 22-week fetus. The IgM fraction of the cord serum contained specific CMV antibodies as demonstrated by indirect hemagglutination and indirect immunofluorescence techniques. This suggests that, under abnormal circumstances such as intra-uterine infections, fetuses may be capable of synthesizing detectable levels of specific IgM antibodies as early as 22 weeks' gestation.

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Novel Risk Score for Fetuses with Congenital Diaphragmatic Hernia Based on Ultrasound Findings

European Journal of Pediatric Surgery ◽

10.1055/s-0039-1698768 ◽

2019 ◽

Vol 30 (01) ◽

pp. 051-058

Author(s):

Keita Terui ◽

Kouji Nagata ◽

Masahiro Hayakawa ◽

Hiroomi Okuyama ◽

Shoichirou Amari ◽

...

Keyword(s):

Prediction Model ◽

Congenital Diaphragmatic Hernia ◽

Risk Score ◽

Diaphragmatic Hernia ◽

Validation Cohort ◽

Prenatal Ultrasound ◽

Odds Ratios ◽

Ultrasound Findings ◽

Liver Herniation ◽

Thoracic Stomach

Abstract Introduction We aimed to establish and validate a risk score for fetuses with congenital diaphragmatic hernia (CDH) using only prenatal ultrasound findings. Material and Methods Derivation (2011–2016, n = 350) and validation (2006–2010, n = 270) cohorts were obtained from a Japanese CDH study group database. Using a logistic regression analysis, we created a prediction model and weighted scoring system from the derivation dataset and calculated the odds ratio of an unsatisfactory prognosis (death within 90 days of life or hospitalization duration exceeding 180 days). Five adverse prognostic factors obtained using prenatal ultrasound, including an observed/expected lung area-to-head circumference ratio (o/eLHR) <25%, liver herniation occupying more than one-third of the thoracic space, thoracic stomach, right-side CDH, and severe malformations, were used as predictors. The obtained model was validated using the validation cohort. Results The unsatisfactory prognosis prediction model was obtained based on the adjusted odds ratios. The C statistics of the model were 0.83 and 0.80 in the derivation and validation datasets, respectively. The five variables were weighted proportionally to their adjusted odds ratios for an unsatisfactory prognosis (o/eLHR <25%, 1 point; liver herniation occupying more than one-third of the thoracic space, 1 point; thoracic stomach, 1 point; right-side CDH, 2 points; and severe malformations, 3 points). Unsatisfactory prognosis rates for the low- (0–2 points), intermediate- (3–5 points), and high-risk (6–8 points) groups were 17, 46, and 100%, respectively (p < 0.001), in the validation cohort. Conclusion Our simple risk score effectively predicted the prognosis of fetuses with CDH.

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P11.15: Prenatal ultrasound findings in a fetus with paternal uniparental disomy 14: the “coat-hanger” sign as a diagnostic clue

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.1542 ◽

2004 ◽

Vol 24 (3) ◽

pp. 332-332

Author(s):

E. Antonelli ◽

L. Curtis ◽

P. Rimensberger ◽

S. Fokstuen ◽

O. Irion ◽

...

Keyword(s):

Uniparental Disomy ◽

Prenatal Ultrasound ◽

Ultrasound Findings ◽

Paternal Uniparental Disomy ◽

Diagnostic Clue ◽

Uniparental Disomy 14

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Congenital Bowing of Long Bones: Prenatal Ultrasound Findings and Diagnostic Dilemmas

Fetal Diagnosis and Therapy ◽

10.1159/000059376 ◽

2002 ◽

Vol 17 (4) ◽

pp. 236-239 ◽

Cited By ~ 11

Author(s):

Chantal Farra ◽

Caroline Piquet ◽

Marc Guillaume ◽

Claude D’Ercole ◽

Nicole Philip

Keyword(s):

Prenatal Ultrasound ◽

Long Bones ◽

Ultrasound Findings

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Follow-up of Toxoplasmosis during Pregnancy: Ten-Year Experience in a University Hospital in Southern Brazil

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0039-1697034 ◽

2019 ◽

Vol 41 (09) ◽

pp. 539-547 ◽

Cited By ~ 2

Author(s):

Amanda Andrade Diesel ◽

Suzana de Azevedo Zachia ◽

Ana Lúcia Letti Müller ◽

Amanda Vilaverde Perez ◽

Flavio Antonio de Freitas Uberti ◽

...

Keyword(s):

Amniotic Fluid ◽

Pregnant Women ◽

Triple Therapy ◽

Gestational Age ◽

Congenital Toxoplasmosis ◽

Immunoglobulin M ◽

University Hospital ◽

Pcr Analysis ◽

Ultrasound Findings

Abstract Objective To describe a population of pregnant women diagnosed with toxoplasmosis and their respective newborns, describing the hospital protocol for treatment and follow-up. Methods Retrospective cohort of pregnant women with acute toxoplasmosis infection and risk of transplacental transmission who were sent to the Fetal Medicine Group of Hospital de Clínicas de Porto Alegre (HCPA) between - January 1, 2006 and December 31, 2016. All patients with confirmed disease were included. The diagnostic protocol and treatment were applied; a polymerase chain reaction (PCR) analysis of the amniotic fluid was used to diagnose toxoplasmosis and determine the treatment. The newborns were followed up at the pediatric outpatient clinic specializing in congenital infection. The patients who were not followed up or were not born in the HCPA were excluded. Results A total of 65 patients were confirmed to have gestational toxoplasmosis; 40 performed amniocentesis, and 6 (15%) were identified as having positive PCR in the amniotic fluid. In five of those cases, this result associated with the gestational age defined the triple therapy during pregnancy, and in one case, it defined the monotherapy (advanced gestational age). A total of 4 of these newborns were treated from birth with triple therapy for 10 months, 1 was not treated (due to maternal refusal), and 1 progressed to death within the first 54 hours of life due to complications of congenital toxoplasmosis. Of the 34 remaining cases with a negative PCR, 33 were treated with monotherapy and 1 was treated with triple therapy (ultrasound findings); of these children, 9 (26.5%) presented negative immunoglobulin G (IgG), 24 (70.6%) presented positive IgG (but none presented positive immunoglobulin M [IgM]), and 1 (2,9%) presented alterations compatible with congenital disease and started treatment with the triple therapy soon after birth. Out of the total sample of 60 patients, among the 25 who did not perform amniotic fluid PCR, 5 were treated with triple therapy (ultrasound findings/prior treatment) and 20 patients were submitted to monotherapy; only two newborns underwent treatment for congenital toxoplasmosis. Among the 65 cases of gestational toxoplasmosis, 6 (9,2%) children had a diagnosis of congenital toxoplasmosis, and 2 patients with triple therapy felt severe adverse effects of the medications. Conclusions The present study suggests that research on PCR screening of the amniotic fluid may be useful to identify patients with a higher potential for fetal complications, who may benefit from the poly-antimicrobial treatment. Patients with negative PCR results must continue to prevent fetal infection with monotherapy, without risk of fetal or maternal impairment.

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