ultrasound diagnosis of fatal anomalies

CYTOMEGALOVIRUS INFECTION
Pratlong F Boulot P, Villena I, et al. Antenatal diagnosis of
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Cytomegalovirus Infection
Definition: Infection with cytomegalovirus, a
DNA virus belonging to the group of herpesviruses.
In adults, this infection occurs
without major symptoms. Infection of the fetus,
however, can lead to severe damage. Transmission
is through the placenta.
Incidence: Some 1–3% of newborn infants excrete
cytomegalovirus, but only 5% of these
show any symptoms in the neonatal period.
About 1–4% of pregnant women are infected
with cytomegalovirus; the primary infection
during pregnancy causes fetal infection in 30%.
Long-term damage may result in 10–15%, particularly
if the primary infection occurs in the first
trimester.
Origin: Cytomegalovirus destroys the infected
cells.
Ultrasound findings: Intracranial calcifications,
microcephaly and obstructive hydrocephalus are
characteristic features. The calcifications are
typically situated on the outside edge of the
lateral cerebral ventricles and in the region of
the basal ganglia. Additional findings are hepatic
calcifications and echogenic bowel. Other
anomalies may also be evident: growth restriction,
fetal hydrops due to anemia, cardiomegaly,
tachycardia, bradycardia, hepatosplenomegaly,
hydronephrosis, hydramnios, possibly oligohydramnios
and placentomegaly.
Differential diagnosis: Cystic fibrosis, trisomy
21, tuberous sclerosis, other intrauterine infections.
Clinical management: Maternal serology, amniotic
fluid culture and PCR; evaluation of amniotic
fluid is more useful than fetal blood. Fetal blood
analysis may still be needed for blood count
(thrombocytopenia, anemia, IgM). Serial scans
are recommended for early detection of anomalies
such as fetal hydrops, hydrocephalus, microcephaly,
and growth restriction.
Procedure after birth: The neonate’s body fluids
are infectious. PCR diagnosis from urine or other
secretions is possible. Treatment with the antiviral
agent ganciclovir is probably ineffective, as
organ damage has already occurred in the intrauterine
stage.
Prognosis: Ninety-five percent of the infants do
not show any clinical symptoms. Of the remainder,
80% will develop neurological symptoms
at a later stage and 30% die in infancy. Of
the asymptomatic infants, some may develop
visual and hearing defects and neurological impairment.
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