Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel.
Ultrasound Obstet Gynecol. 2013 May;41(5):508-14. doi: 10.1002/uog.12377.
To determine the outcome of pregnancies with documented fetal cytomegalovirus (CMV) infection with and without abnormal findings on ultrasound examination and magnetic resonance imaging (MRI).
In this prospective cohort study of pregnant women with documented fetal CMV infection, vertical CMV transmission occurred during the first and second trimesters following primary maternal infection. Patients underwent serial prenatal ultrasound scans and fetal MRI. All neonates underwent ocular fundus examination, ultrasound brain scan and hearing evaluation, and were then followed periodically by a pediatrician.
Primary CMV infection occurred during the first and second trimesters of pregnancy in 71 and 74 patients, respectively. Seven patients (4.8%) decided to terminate pregnancy because of prenatal findings and one neonate died because of CMV complications. Patients with first-trimester infection had infants with significantly more associated sequelae (either auditory damage or neurodevelopmental disabilities) than did patients with second-trimester infection (19.7% vs 5.6%, respectively; P = 0.01). Abnormal prenatal findings on ultrasound examination were associated with increased risk of sequelae. When both ultrasound and MRI findings were normal, the rate of sequelae was decreased to 15.6% for first-trimester infections and to 2.0% for second-trimester infections, partial hearing loss being the sequela in most cases. In the presence of abnormal ultrasound and/or MRI findings the risk was 25% and 16%, respectively, and in most cases the sequelae were deafness and neurodevelopmental delay. The rate of intrauterine growth restriction (IUGR) in the study group was 11.7% and was not affected by the time of onset of maternal infection. Isolated IUGR was not associated with increased risk of sequelae.
The risk of sequelae is higher following first-than second-trimester CMV infection. However, the risk of severe sequelae is significantly reduced in the presence of normal prenatal ultrasound and MRI findings.
确定有和没有超声检查和磁共振成像（MRI）异常发现的记录胎儿巨细胞病毒（CMV）感染妊娠的结局。
在这项有记录的胎儿 CMV 感染孕妇的前瞻性队列研究中，原发性母体感染后第一和第二孕期发生垂直 CMV 传播。患者接受了系列产前超声扫描和胎儿 MRI。所有新生儿均接受了眼部眼底检查、超声脑扫描和听力评估，然后由儿科医生定期随访。
原发性 CMV 感染分别发生在妊娠第一和第二孕期的 71 例和 74 例患者中。7 例（4.8%）因产前发现而决定终止妊娠，1 例新生儿因 CMV 并发症死亡。第一孕期感染的患者发生相关后遗症（听觉损害或神经发育障碍）的比例显著高于第二孕期感染的患者（分别为 19.7%和 5.6%；P=0.01）。超声检查异常的产前发现与后遗症风险增加相关。当超声和 MRI 检查结果均正常时，第一孕期感染的后遗症发生率降至 15.6%，第二孕期感染降至 2.0%，大多数情况下为部分听力丧失。在存在异常超声和/或 MRI 发现的情况下，风险分别为 25%和 16%，大多数情况下的后遗症为耳聋和神经发育迟缓。研究组的宫内生长受限（IUGR）发生率为 11.7%，不受母体感染发病时间的影响。孤立的 IUGR 与后遗症风险增加无关。
第一孕期 CMV 感染后的后遗症风险高于第二孕期。然而，在产前超声和 MRI 检查结果正常的情况下，严重后遗症的风险显著降低。
