title: Secondary cytomegalovirus infection can cause severe fetal sequelae despite maternal preconceptional immunity.
abstract: OBJECTIVE
  To describe our experience in cases with sonographic signs of fetal infection and with maternal serological 'immunity' to cytomegalovirus (CMV) infection.
  
  
  METHODS
  This was a bicenter study of six pregnant women referred for evaluation of suspected fetal infection. All cases had confirmed maternal serology for past exposure to CMV but no evidence of recent secondary CMV infection. All underwent sonographic evaluation as well as complete investigation for CMV infection.
  
  
  RESULTS
  The mean age of the women was 29 (range, 23-35) years and the mean gestational age at diagnosis was 23.5 weeks (range, 20-31) weeks. Sonographic findings included microcephaly, ventriculomegaly, periventricular calcifications and cystic lesions, echogenic bowel, hydrops and hepatosplenomegaly. Amniocentesis was performed in all cases for fetal karyotyping and viral assessment, and all were found by polymerase chain reaction to be positive for CMV infection. Four pregnancies were terminated following the parents' request. One pregnancy continued until intrauterine fetal death occurred 2 weeks after diagnosis. Postmortem was denied in all cases but one. One infant was delivered with evidence of severe cerebral palsy.
  
  
  CONCLUSIONS
  In the presence of sonographic findings suggestive of fetal CMV infection, prompt investigation of amniotic fluid should follow even if maternal serology does not support recent maternal seroconversion.
authors.affiliation: Ultrasound Unit, Department of Obstetrics & Gynecology, Sheba Medical Center, Tel-Hashomer (affiliated with the Sackler School of Medicine, Tel-Aviv University), Israel. zalel_y@netvision.net.il
authors.forename: Y
authors.initials: Y
authors.lastname: Zalel
authors.forename: Y
authors.initials: Y
authors.lastname: Gilboa
authors.forename: M
authors.initials: M
authors.lastname: Berkenshtat
authors.forename: R
authors.initials: R
authors.lastname: Yoeli
authors.forename: R
authors.initials: R
authors.lastname: Auslander
authors.forename: R
authors.initials: R
authors.lastname: Achiron
authors.forename: Y
authors.initials: Y
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000649:Amniocentesis; D000653:Amniotic Fluid / Q000821:virology; D000914:Antibodies, Viral / Q000097:blood; D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000196:embryology / Q000821:virology; D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000196:embryology / Q000821:virology; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000196:embryology / Q000635:transmission*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005315:Fetal Diseases / Q000821:virology*; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000821:virology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007410:Intestinal Diseases / Q000000981:diagnostic imaging / Q000196:embryology / Q000821:virology; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000196:embryology / Q000821:virology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology*; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D016216:Ultrasonography, Prenatal / Q000379:methods; D019562:Viral Load
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral; D007074:Immunoglobulin G