Laurie Barclay, MD

Sept. 9, 2002 — The neurologic outcome of primary maternal cytomegalovirus (CMV) infection is bleak, according to a report published in the September issue of Obstetrics and Gynecology. Even in women who chose not to abort, 19% of infants had postnatal neurologic abnormalities despite negative prenatal ultrasound.

"Positive isolation of CMV accompanied by positive polymerase chain reaction (PCR) values in amniotic fluid provided approximately 94% certainty of in utero CMV infection," write Shlomo Lipitz, MD, and colleagues from Tel Aviv University in Israel. "The risk of postnatal neurologic abnormalities was 19% (3 of 16) when there were no prenatal ultrasonographic abnormalities."

Among 50 pregnancies (51 fetuses) with proven primary maternal infection and vertical transmission of CMV, 33 women (66%) elected pregnancy termination. Ultrasound documented fetal abnormalities in 11 (21.5%) fetuses. Two of these continued to term. Both were congenitally infected, and one had neurologic abnormalities. Of 17 pregnancies (18 fetuses) which continued to term, four fetuses had neurologic abnormalities, and three of these had normal prenatal ultrasound. The remaining 14 had normal prenatal ultrasound and no postnatal neurologic abnormalities.

"The severity of the sonographic abnormalities probably plays an important role in prognosis," the authors write, recommending additional and larger studies. "The significance of mild signs of fetal infection, e.g. hyperechogenic bowel, in the presence of maternal infection is still unknown."

Obstet Gynecol. 2002;100:428-433

Reviewed by Gary D. Vogin, MD

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