ARCHITECTONICS OF THE VENOUS BED OF PLACENTA IN WOMEN WITH THE EXACERBATION OF CHRONIC CYTOMEGALOVIRUS INFECTION IN THE FIRST TRIMESTER OF PREGNANCY

The aim of the study was to assess the architectonics of the venous bed of the fetus part of placenta from women with the exacerbation of cytomegalovirus (CMV) infection in the first trimester of pregnancy. There were examined 75 patients after the term birth, among them there were 25 seropositive women with the exacerbation of CMV infection in the first trimester of pregnancy without clinical signs of threatened miscarriage; 23 seropositive women with the exacerbation of CMV infection in the first trimester of pregnancy and clinical signs of threatened miscarriage; 27 seronegative women without threatened miscarriage. The architectonics of the venous bed of the fetus part was studied with the pressing of contrast (red lead oxide in the linseed oil) through the umbilical vein into the vessels and placenta cotyledons. The roentgen shots were done at the device RUM-20 M “Sapphire”. During the research of the venous bed of the fetus part of placenta from women with the exacerbation of CMV infection and threatened miscarriage in the first trimester of pregnancy there was identified a velamentous attachment of the umbilical cord with the segmentary narrowing and venous varices as well as with the decrease of the outer diameter of veins of preconfluent zone of the fetus part of the organ. There is an increase in the number of asymmetrically located biconfluent venous vessels, the quantity of marginally located and blindly finishing curved vessels of veins and venous roots, which does not provide the effective blood flow and leads to the ischemia of the peripheral (edge) part of placenta. This reduces the delivery of oxygen and metabolites to the fetus, is accompanied with the development of plethora, stasis, thrombosis and inflammation in veins and arteries, as well as the increase of the risk of partial non-progressive separation of normally placed placenta and its partial intimate attachment to the uterus.

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Management of Cytomegalovirus Seroconversion during Pregnancy in France

Fetal Diagnosis and Therapy ◽

10.1159/000381850 ◽

2015 ◽

Vol 39 (1) ◽

pp. 4-12 ◽

Cited By ~ 1

Author(s):

Julie Carrara ◽

Dieynaba S. N'Diaye ◽

Elie Azria ◽

Odile Launay ◽

Flore Rozenberg ◽

...

Keyword(s):

Health Care ◽

First Trimester ◽

Blood Analysis ◽

Final Decision ◽

Fetal Blood ◽

Cmv Infection ◽

Health Care Practitioners ◽

Cerebral Mri ◽

Ultrasound Findings ◽

First Trimester Of Pregnancy

Introduction: Guidelines for the management of cytomegalovirus (CMV) infection of the fetus are rare. Our main objective was to evaluate how health care practitioners in France manage cases of CMV seroconversion during pregnancy. Material and Methods: A questionnaire was e-mailed to health care practitioners potentially concerned by CMV seroconversion during pregnancy. They were asked if they would recommend amniocentesis, fetal cerebral MRI examination and fetal blood analysis (FBA), depending on the ultrasound results. They then had to indicate whether they would accept termination of pregnancy (TOP), depending on the results of these examinations. Results: A total of 380 health care practitioners responded, mainly obstetricians (73.9%) and midwives (20.2%). Overall, 57% of respondents recommended amniocentesis in the case of CMV seroconversion during the first trimester of pregnancy, ultrasound findings being normal. In cases of positive amniocentesis and a major ultrasound abnormality, 84.5% of respondents would perform cerebral MRI, and 44.4% would perform FBA. In this case, the rate of acceptance of TOP was not significantly different whether the examinations were normal (337/372, 90.6%) or not performed (339/374, 93.3%; p = 0.17). Discussion: Amniocentesis is too infrequently used and should be encouraged. The results of MRI and FBA are often not taken into account in the final decision concerning TOP. Guidelines are needed to clarify the management of CMV seroconversion during pregnancy.

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Relative Risk Assessment of Intrauterine Infection of the Fetus During Cytomegalovirus Infection in Early Pregnancy

Acta biomedica scientifica ◽

10.29413/abs.2019-4.3.6 ◽

2019 ◽

Vol 4 (3) ◽

pp. 45-51 ◽

Cited By ~ 1

Author(s):

K. K. Petrova

Keyword(s):

Risk Assessment ◽

Relative Risk ◽

Pregnant Women ◽

Early Pregnancy ◽

Intrauterine Infection ◽

First Trimester ◽

Cmv Infection ◽

Significant Difference ◽

First Trimester Of Pregnancy ◽

Relative Risk Assessment

Background. Intrauterine fetal infection (IUI), the common cause of which is the cytomegalovirus (CMV), occupies one of the first places in the structure of perinatal morbidity and mortality. There are no data on the relative risk assessment of IUI at the exacerbation of CMV infection and its delitescent course in first trimester of pregnancy in the literature.Aim: to calculate the relative risks of fetal IUI in pregnant women with exacerbation of CMV infection in the first trimester of pregnancy.Methods. A retrospective review of the labor and delivery medical records and prenatal records of 104 CMV-seropositive women was carried out. Fifty of these women had an exacerbation of CMV infection in the first trimester of pregnancy – main group and 54 of them were with delitescent course of the disease (comparison group).Results. A comparative analysis of ultrasound and morphological markers of IUI with risk assessment depending on the course of CMV infection in the first trimester of pregnancy has been carried out. A high risk of placental structure abnormalities, as well as amniotic fluid and fetal membranes, fetal and placental blood flow pathology, onset of choroid plexus cyst and fetal growth restriction was found, with a statistically significant difference in the group of pregnant women with exacerbation of CMV infection in the first trimester of pregnancy.Conclusion. The findings suggest that the exacerbation of CMV infection in early pregnancy is a risk factor for IUI.

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P04.04: Is there a neonatal risk from congenital CMV infection beyond the first trimester of pregnancy?

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.20907 ◽

2019 ◽

Vol 54 (S1) ◽

pp. 165-165

Author(s):

S. Lipitz ◽

T. Elkan Miller ◽

T. Weissbach ◽

N. Duvdevani ◽

E. Katorza ◽

...

Keyword(s):

First Trimester ◽

Cmv Infection ◽

Congenital Cmv Infection ◽

First Trimester Of Pregnancy ◽

Congenital Cmv

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Prenatal Diagnosis of Congenital Cytomegalovirus Infection

Journal of Clinical Microbiology ◽

10.1128/jcm.36.12.3540-3544.1998 ◽

1998 ◽

Vol 36 (12) ◽

pp. 3540-3544 ◽

Cited By ~ 44

Author(s):

T. Lazzarotto ◽

B. Guerra ◽

P. Spezzacatena ◽

S. Varani ◽

L. Gabrielli ◽

...

Keyword(s):

At Risk ◽

Prenatal Diagnosis ◽

Predictive Value ◽

Virus Isolation ◽

First Trimester ◽

Cmv Infection ◽

Congenital Cytomegalovirus Infection ◽

Congenital Cytomegalovirus ◽

First Trimester Of Pregnancy ◽

Better Than

We report here the results of a study on the prenatal diagnosis of congenital cytomegalovirus (CMV) infection. The study was carried out by both PCR and virus isolation from amniotic fluid (AF) for 82 pregnant women at risk of transmitting CMV for the detection of (i) seroconversion to CMV immunoglobulin G (IgG) positivity during the first trimester of pregnancy, (ii) symptomatic CMV infection in the mother during the first trimester of pregnancy or intrauterine growth retardation detected by ultrasound or abnormal ultrasonographic findings suggestive of fetal infections, and (iii) seropositivity for CMV-specific IgM. For 50 women, fetal blood (FB) was also obtained and tests for antigenemia and PCR were performed. The results indicate that AF is better than FB for the prenatal diagnosis of CMV infection. PCR with AF has a sensitivity (SNS) of 100%, a specificity (SPE) of 83.3%, a positive predictive value (PPV) of 40%, and a negative predictive value (NPV) of 100%; rapid virus isolation with the same material has an SNS of 50%, an SPE of 100%, a PPV of 100%, and an NPV of 94.7%. Fewer than 10% of the women positive for IgM by enzyme immunoassay (EIA) had a congenitally infected fetus or newborn infant. When EIA IgM positivity was confirmed by Western blotting (WB) and the WB profile was considered, the percent transmission detected among women with an “at-risk” profile was higher than that observed among IgM-positive women and was the same as that among women who seroconverted during the first trimester of pregnancy (transmission rates of 29 and 25%, respectively).

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NICE guideline “Ectopic pregnancy and miscarriage”: new changes and importance for the clinicist

Reproductive Endocrinology ◽

10.18370/2309-4117.2021.62.48-52 ◽

2021 ◽

pp. 48-52

Author(s):

- -

Keyword(s):

Ectopic Pregnancy ◽

Clinical Guidelines ◽

Vaginal Bleeding ◽

Recurrent Miscarriage ◽

First Trimester ◽

Current Data ◽

Nice Guideline ◽

Threatened Miscarriage ◽

Patients At Risk ◽

First Trimester Of Pregnancy

The purpose of this publication is to summarize the current data on the effectiveness of progestogens in patients with threatened miscarriage (vaginal bleeding in the first trimester of pregnancy) and to review the updated UK National Institute for Health and Care Excel (NICE) clinical guidelines on ectopic pregnancy and miscarriage.In accordance with the opinion of the Cochrane Society experts and the updated NICE clinical guidelines for 2021, vaginal progesterone at a dose of 800 mg/day is the only intervention that has been shown to be effective in increasing live births compared to placebo for women with one or more previous miscarriages and early vaginal bleeding (relative risk 1.08, 95% confidence interval 1.02–1.15, high certainty evidence). Upon confirmation of fetal heartbeat, this treatment should be extended until 16 weeks of gestation.There is still uncertainty over the effectiveness and safety of alternative progestogen treatments (as dydrogesterone) for threatened and recurrent miscarriage. There is also no evidence of benefit of any other preparations or doses of progesterone in patients at risk of miscarriage.

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Current practices of management of maternal and congenital Cytomegalovirus infection during pregnancy after a maternal primary infection occurring in first trimester of pregnancy: Systematic review

PLoS ONE ◽

10.1371/journal.pone.0261011 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261011

Author(s):

Claire Périllaud-Dubois ◽

Drifa Belhadi ◽

Cédric Laouénan ◽

Laurent Mandelbrot ◽

Olivier Picone ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Primary Infection ◽

First Trimester ◽

Secondary Outcome ◽

Cmv Infection ◽

Congenital Cmv Infection ◽

First Trimester Of Pregnancy ◽

Congenital Cmv ◽

Current Practices

Introduction Congenital CMV infection is the first worldwide cause of congenital viral infection but systematic screening of pregnant women and newborns for CMV is still debated in many countries. Objectives This systematic review aims to provide the state of the art on current practices concerning management of maternal and congenital CMV infection during pregnancy, after maternal primary infection (PI) in first trimester of pregnancy. Data sources Electronically searches on databases and hand searches in grey literature. Study eligibility criteria and participants Primary outcome was listing biological, imaging, and therapeutic management interventions in two distinct populations: population 1 are pregnant women with PI, before or without amniocentesis; population 2 are pregnant women with congenitally infected fetuses (after positive amniocentesis). Secondary outcome was pregnancy outcome in population 2. Results Out of 4,134 studies identified, a total of 31 studies were analyzed, with 3,325 pregnant women in population 1 and 1,021 pregnant women in population 2, from 7 countries (Belgium, France, Germany, Israel, Italy, Spain and USA). In population 1, ultrasound (US) examination frequency was 0.75/month, amniocentesis in 82% cases, maternal viremia in 14% and preventive treatment with hyperimmune globulins (HIG) or valaciclovir in respectively 14% and 4% women. In population 2, US examination frequency was 1.5/month, magnetic resonance imaging (MRI) in 44% cases at 32 weeks gestation (WG), fetal blood sampling (FBS) in 24% at 28 WG, and curative treatment with HIG or valaciclovir in respectively 9% and 8% patients. Conclusions This systematic review illustrates management of maternal and congenital CMV during pregnancy in published and non-published literature, in absence of international consensus. Systematic review registration PROSPERO CRD42019124342

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P–397 Threatened Miscarriage and increase in Perinatal Morbidity

Human Reproduction ◽

10.1093/humrep/deab130.396 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

R Pillai ◽

D Tincello ◽

N Potdar

Keyword(s):

Early Pregnancy ◽

First Trimester ◽

Low Risk ◽

P Value ◽

Control Cohort ◽

Neonatal Asphyxia ◽

Threatened Miscarriage ◽

First Trimester Of Pregnancy ◽

Asymptomatic Control ◽

In Pregnancy

Abstract Study question Are women presenting with bleeding in the first trimester of pregnancy at a higher risk for perinatal complications later in pregnancy? Summary answer Women presenting with bleeding in the first trimester of pregnancy are more likely to experience perinatal and neonatal morbidity in pregnancy. What is known already Observational studies and a previously reported systematic review showed that women who experienced threatened miscarriage are more likely to have still birth, intra uterine growth restriction (IUGR), low birth weight, pre-eclampsia, placental abruption, placenta previa, preterm labour, preterm prelabour rupture of membrane, neonatal asphyxia and congenital anomalies in pregnancy. However, the evidence has been inconclusive and currently the women who experience threatened miscarriage receive low risk care. Study design, size, duration This was a prospective cohort study conducted on 298 women with threatened miscarriage (Cohort A) and 107 asymptomatic women (Cohort B). The women were recruited over a period of 18 months and were followed up for 9 months until delivery. Participants/materials, setting, methods Cohort A were women who presented with bleeding in the early pregnancy assessment unit and had a confirmed heartbeat on ultrasound scan between 6 weeks and 11 + 6 weeks of pregnancy and cohort B were women who were asymptomatic and booked with the community midwives as low risk. Both groups of women were followed up prospectively until delivery and data were collected on any perinatal outcomes and complications for both mother and the neonate. Main results and the role of chance The analysis showed that women who had bleeding in early pregnancy were more likely to have preterm delivery (RR 95% CI; 2.98 (1.07 – 8.27)); IUGR (unable to calculate the RR, as none of the women who continued their pregnancies beyond 24 weeks of gestation, developed IUGR in the asymptomatic control cohort. Nonetheless, IUGR occurred more frequently in the threatened miscarriage cohort than the asymptomatic cohort (P-value 0.02)); LBW (RR 95% CI; 6.14 (1.49 – 25.19), neonatal asphyxia (unable to calculate the RR, as none of the babies who were born to women in the asymptomatic control cohort develop neonatal asphyxia. Nonetheless, neonatal asphyxia occurred more frequently in the threatened miscarriage cohort than the asymptomatic cohort (P-value 0.02)). Preterm prelabour rupture of membrane was not significant with a P-value of 0.07. Limitations, reasons for caution The major limitation of this study was lower sample size and hence due to the rarity of many of the perinatal and neonatal outcomes, we were unable to calculate the relative risk. Wider implications of the findings: Current study agrees with the existing literature and reaffirms the association of perinatal and neonatal morbidities with threatened miscarriage and this group of women need to be managed as high-risk group antenatally. Trial registration number Not applicable

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DISTURBANCE OF THE PROGESTERONE AND ITS METABOLITES SYNTHESIS IN THE DEVELOPMENT OF NEUROLOGICAL DISORDERS IN CHILDREN AFTER CYTOMEGALOVIRUS INFECTION DURING PREGNANCY

Acta biomedica scientifica ◽

10.29413/abs.2018-3.4.12 ◽

2018 ◽

Vol 3 (4) ◽

pp. 78-84

Author(s):

I. V. Dovzhikova ◽

I. A. Andrievskaya ◽

N. A. Ishutina ◽

I. N. Gorikov ◽

S. V. Medvedeva ◽

...

Keyword(s):

Pregnant Women ◽

Neurological Disorders ◽

First Trimester ◽

Neurological Dysfunction ◽

Viral Agent ◽

Cmv Infection ◽

First Trimester Of Pregnancy ◽

Latent Disease ◽

One Year ◽

The Impact

Cytomegalovirus (CMV) infection is one of the causes of congenital neurological disorders and the virus itself is the most common viral agent causing an imbalance in the production of placenta progesterone and its neuroactive metabolites – allopregnenolone and 5α-dihydroprogesterone. The aim was to evaluate the concentration of progesterone and its metabolites – 5α-dihydroprogesterone and allopregnenolone – in placenta during exacerbation of CMV infection in the first trimester of pregnancy, and the impact of these disturbances on the development of neurological disorders in children. We examined 30 pregnant women with exacerbation of CMV infection in the first trimester of pregnancy and 30 pregnant women with latent disease; and later their newborns. The enzyme immunoassay was used to determine concentration of progesterone in placenta; the histochemical method – to determine 5α-dihydroprogesterone and allopregnenolone. Newborns underwent neurosonography studies. Exacerbation of CMV infection in the first trimester of pregnancy decreased progesterone in placenta by 1.3 times, 5α-dihydroprogesterone – by 1.73 times and allopregnenolone – by 2 times. Ultrasound examination of the brain showed ventriculomegaly, periventricular ischemia, and pseudocysts in newborns up to one year from mothers with exacerbation of CMV during pregnancy. Later, minimal brain dysfunctions were manifested by motor disorders, increased general, vegetative excitability, and a tendency to digestive and sleep disorders. The data obtained indicate that the exacerbation of CMV infection in the first trimester of pregnancy is interrelated with a decrease in the concentration of progesterone and its metabolites (5α-dihydroprogesterone, allopregnenolone) in the placenta and development of neurological dysfunction in newborns.

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