title: Analysis of blood from Zika virus-infected fetuses: a prospective case series.
abstract: Zika virus has spread through the Americas and the Caribbean since early 2015 and was rapidly declared a Public Health Emergency of International Concern by WHO because of the potential association with fetal anomalies. We analysed fetal and maternal fluids and tissues in fetuses with confirmed Zika virus infection prospectively monitored in Martinique, a French Caribbean island.
  
  
  
  Since the beginning of the Zika virus outbreak in Martinique, all pregnant women undergo monthly fetal ultrasound examination surveillance. In this study, we prospectively studied all patients with fetal anomalies and a positive amniotic fluid for Zika virus by RT-PCR. Maternal and fetal blood, urine, amniotic fluid, placenta, and fetal tissues were tested for Zika virus by RT-PCR. Fetal blood was analysed to identify haematological and biological anomalies.
  
  
  
  Between Jan 1, 2016, and Nov 10, 2016, we recruited eight cases of Zika virus infection. All but two cases were symptomatic during the first trimester. Fetal anomalies were only detected after 20 weeks' gestation. After an initial positive result, amniocentesis became negative in two cases and fetal blood was transiently Zika virus-positive in six cases. Fetal blood analyses showed a cholestatic pattern, anaemia, and infectious response.
  
  
  
  Normalisation of amniotic fluid and fetal blood for Zika virus, as well as maternal blood and urine, shows the limitations of the performance of these investigations, due to the possibility of false negative results. Abnormal fetal blood needs to be investigated further to establish prognostic factors of severe Zika virus infections.
  
  
  
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authors.affiliation: Centre Pluridisciplinaire de Diagnostic Prénatal de Martinique, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France; Service de Gynécologie Obstétrique, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France; Registre des Malformations des Antilles, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Schaub
authors.affiliation: Materno-fetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, University Hospital, Lausanne, Switzerland; Institute of Microbiology, Faculty of Biology and Medicine, University of Lausanne and University Hospital, Lausanne, Switzerland.
authors.forename: Manon
authors.initials: M
authors.lastname: Vouga
authors.affiliation: Service de Virologie, Hôpital de la Meynard, Centre Hospitalier Universitaire de Martinique, Fort de France, France.
authors.forename: Fatiha
authors.initials: F
authors.lastname: Najioullah
authors.affiliation: Centre Pluridisciplinaire de Diagnostic Prénatal de Martinique, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France; Service de Gynécologie Obstétrique, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Gueneret
authors.affiliation: Service de Gynécologie Obstétrique, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Monthieux
authors.affiliation: Service de Gynécologie Obstétrique, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Harte
authors.affiliation: Laboratoire de Biochimie, Hôpital Robert-Debré, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Muller
authors.affiliation: Centre Pluridisciplinaire de Diagnostic Prénatal de Martinique, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France; Service de Gynécologie Obstétrique, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France.
authors.forename: Eugénie
authors.initials: E
authors.lastname: Jolivet
authors.affiliation: Centre Pluridisciplinaire de Diagnostic Prénatal de Martinique, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France; Service de Radiologie, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France.
authors.forename: Clara
authors.initials: C
authors.lastname: Adenet
authors.affiliation: Laboratoire de Biochimie, Hôpital Robert-Debré, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Dreux
authors.affiliation: Centre National de Référence des Arboviroses, Institut de Recherche Biomédicale des Armées, Marseille, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Leparc-Goffart
authors.affiliation: Service de Virologie, Hôpital de la Meynard, Centre Hospitalier Universitaire de Martinique, Fort de France, France; University Antilles, Fort-de-France, France.
authors.forename: Raymond
authors.initials: R
authors.lastname: Cesaire
authors.affiliation: Centre Pluridisciplinaire de Diagnostic Prénatal de Martinique, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France; Service de Gynécologie Obstétrique, Maison de la Femme de la Mère et de l'Enfant, Centre Hospitalier Universitaire de Martinique, Fort de France, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Volumenie
authors.affiliation: Materno-fetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, University Hospital, Lausanne, Switzerland; Institute of Microbiology, Faculty of Biology and Medicine, University of Lausanne and University Hospital, Lausanne, Switzerland. Electronic address: david.baud@chuv.ch.
authors.forename: David
authors.initials: D
authors.lastname: Baud
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000652:urine; D005260:Female; D005312:Fetal Blood / Q000821:virology*; D005333:Fetus / Q000002:abnormalities / Q000000981:diagnostic imaging; D006801:Humans; D008395:Martinique; D008831:Microcephaly / Q000175:diagnosis / Q000000981:diagnostic imaging; D010920:Placenta; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D012367:RNA, Viral; D000071244:Zika Virus / Q000302:isolation & purification*; D000071243:Zika Virus Infection / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000635:transmission
chemical_list: D015415:Biomarkers; D012367:RNA, Viral