Chow S S W, Craig M E, Jacques C F H, Hall B, Catteau J, Munro S C, Scott G M, Camaris C, McIver C J, Rawlinson W D
Department of Microbiology, Virology Division, SEALS, Prince of Wales Hospital, Randwick, New South Wales, Australia.
J Med Virol. 2006 Jun;78(6):747-56. doi: 10.1002/jmv.20618.
Vertical transmission of viruses is an important cause of morbidity in the fetus and neonate. Placental viral infection indicates risk of vertical transmission, but not always transmission to, or disease of the fetus. Specimens from mothers and babies from three groups-two prospective and one retrospective cohort-were tested for pathogens of teratogenic potential using multiplex PCR. Placental infection was present in 13% of the 105 samples collected. Assessment of the prospective cohorts showed cytomegalovirus (CMV) detected in 4% of placentae from unselected women, parvovirus B19 in 1% and Ureaplasma parvum in 1% of placentae. In a retrospective cohort of women at high risk of transmitting congenital infection due to seroconversion during pregnancy, miscarriage or stillbirth, CMV was detected in 64% and human herpes virus type 7 in 9% of placentae. Of 14 PCR-positive placentae, two were associated with the birth of a living symptomatic infant, two with stillbirth, one with miscarriage, and two with elective terminations of pregnancy. Directed laboratory assessment of women at high risk of transmitting congenital infection, on the basis of clinical or laboratory markers, is important for accurate diagnosis of adverse outcomes of pregnancy. However, routine screening for viruses in the placentae from women with a low-risk serological profile for transmitting congenital infection is unlikely to result in significant numbers of additional diagnoses and is confounded by inadequacy of current diagnostic methods. The major pathogen detected in all cases of placental infection associated with fetal death was human CMV.
病毒的垂直传播是导致胎儿和新生儿发病的一个重要原因。胎盘病毒感染表明存在垂直传播风险，但并不总是会传播给胎儿或导致胎儿患病。使用多重聚合酶链反应（PCR）对来自三组（两组前瞻性队列和一组回顾性队列）的母亲和婴儿样本进行了致畸病原体检测。在采集的105份样本中，13%存在胎盘感染。对前瞻性队列的评估显示，在未筛选女性的胎盘中，4%检测到巨细胞病毒（CMV），1%检测到细小病毒B19，1%检测到微小脲原体。在一组因孕期血清转化、流产或死产而有先天性感染传播高风险的回顾性队列女性中，64%的胎盘检测到CMV，9%检测到人类疱疹病毒7型。在14份PCR阳性的胎盘中，两份与有症状活产婴儿的出生有关，两份与死产有关，一份与流产有关，两份与选择性终止妊娠有关。基于临床或实验室指标，对有先天性感染传播高风险的女性进行定向实验室评估，对于准确诊断妊娠不良结局很重要。然而，对先天性感染传播血清学特征风险低的女性胎盘进行病毒常规筛查，不太可能导致大量额外诊断，且因当前诊断方法的不足而受到干扰因素影响。在所有与胎儿死亡相关的胎盘感染病例中检测到的主要病原体是人类CMV。
