Prenatal diagnosis of fetal cytomegalovirus infection Monique E. Lamy, MD,. Kipanga N. Mulongo, MD,. Jean-Fram,ois Gadisseux, MD," Gilbert Lyon, MD,b Veronique Gaudy, MD,c and Michel Van Lierde, MDc Brussels, Belgium A prospective study (1988 to 1990) to evaluate the risk of fetal cytomegalovirus transmission was conducted with 1771 pregnant women; the test results of 861 were seronegative (48.6%). At each prenatal visit they were tested for serologic data and cytomegalovirus excretion in urine, saliva, and cervical secretions. If seroconverslon occurred (with or without cytomegalovirus excretion), ultrasonography, amniocentesis, and cordocentesis were performed at 22 weeks' gestation; 7 cases of primary cytomegalovirus infection were investigated. In 5 cases the amniotic fluid cultures were positive; in 3 cases the fetal blood test results were positive for specific immunoglobulin M; and in 2 cases brain ultrasonography results were positive. Infection was confirmed with biopsies of fetal tissue. In two other cases, the cord blood and amniotic fluid test results were negative, and the neonates were free of infection. (AM J OBSTET GVNECOL 1992;166:91-4.)

Key words: Prenatal, cytomegalovirus, amniocentesis, cordocentesis, ultrasonography Cytomegalovirus is considered to be the first cause of congenital infection. 1 Maternal infections are mostly asymptomatic; however, transplacental transmission occurs in about 50% of cases. 2 Furthermore, 90% of infected neonates show no clinical signs of infection at birth, although some will have late manifestations of

congenital cytomegalovirus infection? Prenatal diagnosis is therefore essential to detect those fetuses at risk of having symptoms and late sequelae. In a prospective survey seven cases of primary cytomegalovirus infection were investigated for fetal transmission. In addition to detecting specific immunoglobulin M (IgM) antibodies with cord blood tests and fetal brain echography, we emphasized virus isolation from amniotic fluid culture for antenatal diagnosis.

From the Departments oJVzrolo/sy," NeUlopediatno,b and ObstetrzC5,' Catholzc UnivPrslly oj Louvaln. Suppmted by a grant Jrom the Marguerite Marze Delacrozx Foundation and by Fonds National de Recherche Sczentzjique and Fonds de Recherche SClentifique Medzcale Conventzon Jor Neuropatholo/sy Studzes. RecezvedJor publzcatlOnJanuary 8,1991: revz;ed May 9,1991: accepted July 16, 1991. Reprint request I: Monzque E. Lamy, MD, Department oj Vlrolo/sy, E.5.P., U C.L., 30155 Clos Chapelle aux Champs, 1200 Brussels, Belglum. 611 132433

Material and methods Patients. A prospective study was conducted with 1771 pregnant women; the test results of 861 were seronegative (48.6%). At each prenatal visit they were tested for serologic data and cytomegalovirus excretion in urine, saliva, and cervical secretions. If sero-

Table I. Prenatal diagnosis of cytomegalovirus infection Cordocenteszs

Case No.

Age (yr)

G,P

GestatIOnal age at przmary InJectlOn (wh)

I 2

27 29

G2, PI G2, PI

7-15 8-12

3

26

G3, P2

9-13

4

27

G2, PI