Second Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
EA Fetus, Paris Descartes University, University of Paris, Paris, France.
Ultrasound Obstet Gynecol. 2023 Feb;61(2):158-167. doi: 10.1002/uog.26128.
Cytomegalovirus (CMV) DNA is detectable in the amniotic fluid collected by amniocentesis in cases in which the fetus has been infected. However, cases of congenital neonatal CMV infection with a negative amniocentesis result have also been reported in the literature. The aim of the present study was to compare pregnancies with a negative amniocentesis result to those with a positive amniocentesis result in terms of incidence of fetal insult and long-term sequelae.
Observational studies that included pregnant women with CMV infection who underwent amniocentesis and that reported their results together with neonatal and/or long-term outcomes of the offspring were included. The risk of bias in included studies was assessed using the Newcastle-Ottawa Scale. The rate of severe symptoms at birth, defined as neurological symptoms or multiorgan involvement at birth, and the rate of severe sensorineural hearing loss (SNHL) and/or neurodevelopmental impairment at follow-up were the main outcomes of the study. The secondary outcome was the rate of pregnancy termination due to the presence of CMV-associated central nervous system (CNS) findings or multiorgan involvement on ultrasound/magnetic resonance imaging (MRI).
Seven studies were included in the systematic review and meta-analysis. The pooled false-negative rate of amniocentesis was 8.0% (95% CI, 5.0-13.0%). The pooled rate of severe symptoms at birth was 0.0% (95% CI, 0.0-1.0%; I = 0%) in fetuses with a negative amniocentesis result and 22.0% (95% CI, 11.0-38.0%; I = 75%) in those with a positive amniocentesis result. The pooled odds ratio (OR) was 0.03 (95% CI, 0.01-0.10; I = 0%). The pooled rate of severe SNHL and/or neurodevelopmental impairment at follow-up in fetuses with a negative amniocentesis result was 0.0% (95% CI, 0.0-1.0%; I = 0%) and, in those with a positive amniocentesis result, it was 14.0% (95% CI, 7.0-26.0%; I = 64%). The pooled OR was 0.04 (95% CI, 0.01-0.14; I = 0%). The pooled rate of pregnancy termination due to the presence of CMV-associated CNS findings or multiorgan involvement on ultrasound/MRI was 0.0% (95% CI, 0.0-2.0%; I = 0%) in fetuses with a negative amniocentesis result and 20.0% (95% CI, 10.0-36.0%; I = 82%) in those with a positive amniocentesis result. The pooled OR was 0.03 (95% CI, 0.01-0.08; I = 0%). A subgroup analysis including only pregnancies with primary CMV infection and a sensitivity analysis including only prospective studies were carried out, showing very similar results to those of the main analysis.
A negative amniocentesis result in pregnant women with CMV infection ensures lack of fetal insult and long-term sequelae to the child, even if transmission has occurred. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
在胎儿已感染的情况下，通过羊膜穿刺术收集的羊水可检测出巨细胞病毒 (CMV) DNA。然而，文献中也报道了一些先天性新生儿 CMV 感染且羊膜穿刺术结果为阴性的病例。本研究旨在比较羊膜穿刺术结果为阴性和阳性的妊娠病例，以评估胎儿损伤和长期后遗症的发生率。
纳入了接受羊膜穿刺术并报告了结果以及新生儿和/或后代长期结局的 CMV 感染孕妇的观察性研究。使用纽卡斯尔-渥太华量表评估纳入研究的偏倚风险。主要研究结果是出生时严重症状的发生率，定义为出生时存在神经症状或多器官受累；以及出生后严重感觉神经性听力损失 (SNHL) 和/或神经发育障碍的发生率。次要结局是由于存在与 CMV 相关的中枢神经系统 (CNS) 发现或超声/磁共振成像 (MRI) 显示多器官受累而终止妊娠的发生率。
系统评价和荟萃分析纳入了 7 项研究。羊膜穿刺术的假阴性率为 8.0%（95%置信区间，5.0-13.0%）。羊膜穿刺术结果为阴性的胎儿中，出生时存在严重症状的发生率为 0.0%（95%置信区间，0.0-1.0%；I²=0%），而羊膜穿刺术结果为阳性的胎儿中，该发生率为 22.0%（95%置信区间，11.0-38.0%；I²=75%）。汇总比值比（OR）为 0.03（95%置信区间，0.01-0.10；I²=0%）。羊膜穿刺术结果为阴性的胎儿中，出生后存在严重 SNHL 和/或神经发育障碍的发生率为 0.0%（95%置信区间，0.0-1.0%；I²=0%），而羊膜穿刺术结果为阳性的胎儿中，该发生率为 14.0%（95%置信区间，7.0-26.0%；I²=64%）。汇总 OR 为 0.04（95%置信区间，0.01-0.14；I²=0%）。羊膜穿刺术结果为阴性的胎儿中，由于存在与 CMV 相关的 CNS 发现或多器官受累而终止妊娠的发生率为 0.0%（95%置信区间，0.0-2.0%；I²=0%），而羊膜穿刺术结果为阳性的胎儿中，该发生率为 20.0%（95%置信区间，10.0-36.0%；I²=82%）。汇总 OR 为 0.03（95%置信区间，0.01-0.08；I²=0%）。进行了仅包括原发性 CMV 感染的亚组分析和仅包括前瞻性研究的敏感性分析，结果与主要分析非常相似。
CMV 感染孕妇的羊膜穿刺术结果为阴性可确保胎儿无损伤和长期后遗症，即使已经发生了传播。© 2022 作者。约翰威立父子公司出版的《超声妇产科杂志》由国际妇产科超声学会代表出版。
