Rao Rashmi, Gaw Stephanie L, Han Christina S, Platt Lawrence D, Silverman Neil S
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, California.
Obstet Gynecol. 2017 Jun;129(6):1098-1103. doi: 10.1097/AOG.0000000000002049.
To describe a single U.S. perinatal center's ongoing experience with evaluating pregnant patients with potential exposure to Zika virus infection.
This is an institutional review board-approved longitudinal observational study from January to August 2016 from a single perinatal referral center. Patients who had traveled to or had sexual contact with a person who traveled to a region with documented local Zika virus transmission were included in the study. The aim of the study was to identify the rate of confirmed infection among pregnant women referred to our center with established risk factors for Zika virus acquisition. We also sought to characterize travel patterns that constituted risk, to identify rates of symptoms suggesting infection, and to potentially describe findings suggestive of congenital Zika virus infection in prenatal ultrasound evaluations.
We evaluated 185 pregnant women with potential Zika virus exposure. Testing was offered in accordance with the version of the Centers for Disease Control and Prevention guidelines in place at the time of the consultation visit. Geographic exposure data showed Mexico (44%), the Caribbean (17%), North America (16%), South America (13%), and Central America (9%) to be the most common areas in which potential exposure occurred. One hundred twenty-three (67%) patients reported insect bites and 19 (10%) patients reported symptoms. Overall, five (3% of all) patients had prenatal ultrasound findings suggestive of possible fetal Zika virus infection; all their Zika virus test results returned negative. These findings included microcephaly, echogenic intracardiac foci, and ventricular calcifications. Of the 153 Zika virus screening tests ordered, eight (5%) immunoglobulin M results returned positive or equivocal with only one positive through confirmatory testing. Overall, 1 of 185 (0.5%) of all those consulted and 1 of 153 (0.7%) of those tested had a confirmed Zika virus infection with no confirmed fetal or neonatal infections.
We identified low rates of confirmed maternal Zika virus infection in our cohort, but the number of patients described here demonstrates the magnitude of concern existing among both patients and physicians regarding possible perinatal Zika virus infection. It also underscores the need for health care providers to be prepared to answer questions, explain laboratory and ultrasound results, and describe testing options for concerned patients and their families.
描述美国一家围产期中心在评估可能感染寨卡病毒的孕妇方面的持续经验。
这是一项经机构审查委员会批准的纵向观察性研究，研究时间为2016年1月至8月，研究地点为一家围产期转诊中心。前往有记录表明当地存在寨卡病毒传播的地区旅行或与前往该地区旅行的人有性接触的患者被纳入研究。该研究的目的是确定因有感染寨卡病毒的既定风险因素而被转诊至我们中心的孕妇中确诊感染的比例。我们还试图描述构成风险的旅行模式，确定提示感染的症状发生率，并在产前超声评估中描述提示先天性寨卡病毒感染的发现。
我们评估了185名可能接触寨卡病毒的孕妇。检测是根据咨询就诊时适用的疾病控制与预防中心指南版本进行的。地理暴露数据显示，墨西哥（44%）、加勒比地区（17%）、北美洲（16%）、南美洲（13%）和中美洲（9%）是潜在暴露最常见的地区。123名（67%）患者报告有蚊虫叮咬，19名（10%）患者报告有症状。总体而言，5名（占所有患者的3%）患者的产前超声检查结果提示可能存在胎儿寨卡病毒感染；她们所有的寨卡病毒检测结果均为阴性。这些发现包括小头畸形、心内强回声灶和脑室钙化。在开出的153份寨卡病毒筛查检测中，8份（5%）免疫球蛋白M结果呈阳性或疑似阳性，经确认检测只有1份呈阳性。总体而言，在所有接受咨询的185名患者中有1名（0.5%）以及在接受检测的153名患者中有1名（0.7%）确诊感染寨卡病毒，未确诊有胎儿或新生儿感染。
我们在队列中确定了确诊的孕妇寨卡病毒感染率较低，但此处描述的患者数量表明患者和医生对可能的围产期寨卡病毒感染都极为关注。这也强调了医疗保健提供者需要准备好回答问题、解释实验室和超声检查结果，并为相关患者及其家属描述检测选项。
