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Melo A, de Sales Tavares J, de Assis Costa M, Santana de Aguiar R, Malinger G, de Oliveira Melo F, Balbino da-Silva M, Luiz Fonseca Schamber-Reis B, Gama G, Tanuri A, Chimelli L, Oliveira-Szejnfeld P, M Ramos de Amorim M. Obstetric and perinatal outcomes in cases of congenital Zika syndrome. Prenat Diagn 2020; 40:1732-1740. [PMID: 32939752 DOI: 10.1002/pd.5831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe obstetric and perinatal outcomes in cases of congenital Zika syndrome (CZS). METHODS A dual prospective and retrospective cohort study involving 102 pairs of mothers and fetuses/children with CZS whose infection was confirmed by testing for the Zika virus in amniotic fluid, umbilical cord blood, and fragments from the placenta of the newborn infant (confirmed CZS), or by intrauterine imaging tests (neurosonography), and/or postnatal computed tomography (presumed CZS). RESULTS Suspicion of CZS was investigated by ultrasonography during pregnancy in 52.9% of cases. The principal prenatal imaging findings were ventriculomegaly (43.1%) and microcephaly (42.2%). Median gestational age at delivery was 39 weeks, with 15.7% being premature. Mean head circumference at birth was 30.0 ± 2.3 cm, with 66% of cases being classified as having microcephaly. Arthrogryposis was found in 10 cases (9.8%). There were no fetal deaths; however, nine neonatal deaths were recorded, and three autopsies were performed. CONCLUSION Neonatal mortality was high, almost 10%. Regarding the abnormalities of CZS, microcephaly, although common, was not present in all cases and intracranial findings need to be taken into consideration for diagnosis. Therefore, ultrasound screening during pregnancy should be systematized and expanded in endemic zones.
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Affiliation(s)
- Adriana Melo
- Instituto de Pesquisa Professor Amorim Neto (IPESQ), Campina Grande, Brazil.,UNIFACISA, Campina Grande, Brazil.,Federal University of Campina Grande (UFCG), Campina Grande, Brazil
| | | | | | | | - Gustavo Malinger
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Gabriela Gama
- Instituto de Pesquisa Professor Amorim Neto (IPESQ), Campina Grande, Brazil.,UNIFACISA, Campina Grande, Brazil
| | - Amilcar Tanuri
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leila Chimelli
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Patricia Oliveira-Szejnfeld
- Federal University of São Paulo, São Paulo, Brazil.,Instituto D'Or de Pesquisa (IDOR), Rio de Janeiro, Brazil
| | - Melania M Ramos de Amorim
- Instituto de Pesquisa Professor Amorim Neto (IPESQ), Campina Grande, Brazil.,Federal University of Campina Grande (UFCG), Campina Grande, Brazil.,Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
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Roee B, Adi W, Michael B, Igal W, Karina KH, Liat BS, Gustavo M. Subtle findings on fetal brain imaging in CMV infected pregnancies: What is the clinical significance? A retrospective analysis with outcome correlation. Prenat Diagn 2020; 40:447-453. [PMID: 31875430 DOI: 10.1002/pd.5634] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/31/2019] [Accepted: 12/07/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe the prognosis of subtle findings on fetal brain imaging in pregnant women with primary CMV infection during pregnancy. METHODS This was a retrospective study. The data included: timing of infection, amniocentesis results, imaging findings, obstetric outcome, and developmental assessment. RESULTS For the 27 included patients, the time of infection was: periconception, first, second, third trimesters or unknown in 14.8%, 29.7%, 40.7%, 7.4%, and 7.4%, respectively. Seventy-four percent had only MRI findings; white matter hyperintense T2 signal (HT2) (51.8%), mild ventriculomegaly (18.5%), HT2 and temporal cyst (7.4%), dilated occipital horn (7.4%), Periventricular pseudo cyst (PVPC) with dilated occipital horn (3.7%), isolated PVPC (7.4%), choroid plexus cyst (3.7%). In 26% of fetuses, additional ultrasound findings were observed: Lenticulostriatal vasculopathy (LSV) (11.1%), LSV with PVPC (3.84%), isolated PVPC (3.84%), mild ventriculomegaly (3.84%), and bilateral temporal cysts (3.84%). In 66.6%, the MRI had false-positive findings (due to noninfected neonates). All children are developing normally, and one has a hearing deficit. Postnatal ultrasound (US) was normal in 21/27, with LSV in five, and a resolving subependymal cyst in one patient. CONCLUSION Subtle imaging findings are more common on MRI than US and the prognosis is most likely favorable. Performing amniocentesis will significantly reduce the false-positive rate.
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Affiliation(s)
- Birnbaum Roee
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Winsteen Adi
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Brusilov Michael
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Wolman Igal
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Krajden Haratz Karina
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ben-Sira Liat
- Pediatric Radiology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Malinger Gustavo
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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