Liesnard C, Donner C, Brancart F, Gosselin F, Delforge M L, Rodesch F
Laboratory of Virology, Departments of Obstetrics and Gynecology, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Obstet Gynecol. 2000 Jun;95(6 Pt 1):881-8. doi: 10.1016/s0029-7844(99)00657-2.
To develop recommendations for prenatal diagnosis of congenital cytomegalovirus (CMV) infection and evaluate possible prognostic markers.
We studied 237 pregnant women who had suspected or confirmed primary CMV infections by amniocenteses with or without funipuncture. Diagnosis of CMV was based on culture and polymerase chain reaction (PCR) done on amniotic fluid (AF) samples; fetal blood tests for CMV immunoglobulin M antibodies, PCR, and nonspecific biologic markers; and repeated ultrasound examinations. In cases of pregnancy termination, viral and pathologic examinations of fetuses were done. At birth, CMV infections were sought in newborns. Pediatric follow-up was scheduled for at least 2 years.
Of 210 fetuses and newborns correctly evaluated, 55 had CMV infections. Ten of 38 fetuses infected before 20 weeks' pregnancy had severe congenital disease. The global sensitivity of prenatal diagnosis was 80%. Best sensitivity and 100% specificity were achieved by PCR done on AF sampled after 21 weeks' gestation, respecting a mean interval of 7 weeks between diagnosis of maternal infection and prenatal diagnosis. Fetal thrombocytopenia was associated with severe fetal disease. Ultrasound follow-up missed two fetuses who presented with neurologic impairment due to CMV after birth.
A reliable prenatal diagnosis of congenital CMV infection based on PCR on amniocentesis samples can be made after 21 weeks' pregnancy, after a 7-week interval between diagnosis of maternal infection and antenatal procedure. Ultrasound and nonspecific biologic parameters are not sufficient to identify all fetuses at risk of severe sequelae.
制定先天性巨细胞病毒（CMV）感染的产前诊断建议，并评估可能的预后标志物。
我们研究了237例孕妇，她们通过羊膜穿刺术（有或无脐血穿刺）怀疑或确诊为原发性CMV感染。CMV诊断基于对羊水（AF）样本进行的培养和聚合酶链反应（PCR）；胎儿血液检测CMV免疫球蛋白M抗体、PCR和非特异性生物学标志物；以及重复超声检查。对于终止妊娠的病例，对胎儿进行病毒学和病理学检查。在出生时，对新生儿进行CMV感染检测。安排至少2年的儿科随访。
在210例正确评估的胎儿和新生儿中，55例有CMV感染。在妊娠20周前感染的38例胎儿中，10例有严重先天性疾病。产前诊断的总体敏感性为80%。在妊娠21周后采集的AF样本上进行PCR，在母体感染诊断和产前诊断之间平均间隔7周时，可实现最佳敏感性和100%特异性。胎儿血小板减少与严重胎儿疾病相关。超声随访漏诊了2例出生后因CMV出现神经损伤的胎儿。
在妊娠21周后，在母体感染诊断和产前检查间隔7周后，基于羊膜穿刺术样本的PCR可对先天性CMV感染进行可靠的产前诊断。超声和非特异性生物学参数不足以识别所有有严重后遗症风险的胎儿。
