Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary/Alberta Health Services, Calgary, Alberta, Canada,
Fetal Diagn Ther. 2020;47(9):653-664. doi: 10.1159/000508042. Epub 2020 Jun 19.
The prevalence of perinatal infection from maternal exposure is increasing. The prevalence of acute maternal infections identifies cytomegalovirus, parvovirus B19, toxoplasmosis, and varicella as the most common organisms and in the order of frequency. Maternal informed consent and understanding is required before intrauterine testing for fetal infectious and possible genetic risk assessment.
This structured review of the reproductive published literature focuses on the risks of amniocentesis and cordocentesis diagnostic procedure-related fetal loss rates and fetal vertical transmission (VT) rates from published infected pregnant cohorts.
The total postprocedure fetal loss rate for diagnostic amniocentesis procedures, in limited infectious cohorts, is 1.5% and does not appear to be increased compared to "noninfected" amniocentesis cohorts using an estimated background spontaneous fetal loss rate (no procedure) of 0.65%. The "pooled" unintended fetal loss rate is from small infected population cohorts, but can be used for counseling purposes. Postcordocentesis fetal loss risk, in an infected cohort, is not possible to estimate due to limited data. The "biological spontaneous fetal loss rate" risk with a perinatal infection (positive or negative fetal anomalies) and no diagnostic procedure before 20 weeks of gestation is reviewed. The risk of VT in acute infection cohorts as a result of the intra-amniotic diagnostic procedure is not found to be increased.
The unintended "fetal loss" rate after amniocentesis for perinatal infected cohorts is similar to that of noninfected cohorts, but the estimate is based on limited infected cohorts. There was no procedure-based risk of fetal VT in the infected cohorts, but identification of postprocedure maternal bleeding into the amniotic cavity increases the potential risk. Maternal knowledge translation and an informed consent process with risk-benefit maternal/fetal risk counseling are required prior to any diagnostic amniocentesis procedure.
母婴暴露所致围产期感染的患病率正在上升。急性母体感染的患病率确定巨细胞病毒、细小病毒 B19、弓形虫病和水痘带状疱疹病毒为最常见的病原体，按频率顺序排列。在对胎儿进行宫内感染和可能的遗传风险评估之前，需要获得母体知情同意和理解。
本研究对已发表的生殖文献进行了系统回顾，重点关注羊膜腔穿刺术和脐带穿刺术诊断性操作相关的胎儿丢失率以及来自已发表的感染孕妇队列的胎儿垂直传播 (VT) 率。
在有限的感染队列中，诊断性羊膜腔穿刺术的总术后胎儿丢失率为 1.5%，与使用估计的背景自发性胎儿丢失率（无操作）为 0.65%的“非感染”羊膜腔穿刺术队列相比，似乎并未增加。“汇总”意外胎儿丢失率来自小的感染人群队列，但可用于咨询目的。由于数据有限，无法估计感染队列中脐带穿刺术后的胎儿丢失风险。回顾了围产期感染（阳性或阴性胎儿异常）且在妊娠 20 周前无诊断性操作时的“生物学自发性胎儿丢失”风险。在急性感染队列中，由于羊膜腔内诊断性操作而导致的 VT 风险并未增加。
对于围产期感染队列，羊膜腔穿刺术后的意外“胎儿丢失”率与非感染队列相似，但估计值基于有限的感染队列。在感染队列中，没有因操作而导致胎儿 VT 的风险，但在羊膜腔内检测到术后母体出血会增加潜在风险。在进行任何羊膜腔穿刺术之前，需要对母体进行知识转化并进行知情同意过程，对母体/胎儿风险进行风险-效益比的咨询。
