Primary maternal cytomegalovirus infections: accuracy of fetal ultrasound to predict sequelae in offspring Reply

We thank Picone and Mandelbrot for their interesting comments. In Belgium, 3 prenatal ultrasound scans are refunded by the Federal Institute for Health Insurance (1st, 2nd, and 3rd trimester ultrasound examinations). As mentioned in our article, pregnant patients with primary cytomegalovirus infections were invited for targeted additional ultrasound scans to be performed every 4 weeks until delivery. Dates of the ultrasound scans and gestational ages for every included patient were registered (data not shown) as well as fetal and placental findings. We share the same opinion about correlations between autopsy findings and clinical postnatal cytomegalovirus impairments. Histopathologic observations should be interpretated with caution to avoid overestimation of adverse outcomes. On the other hand, underestimation of adverse outcomes should not be neglicted. A few patients in this study declined autopsy or were lost for follow-up. For several cases of pregnancy terminations, neuropathological examinations failed because of fetal brain tissue autolyse. Underestimation of adverse outcomes or missed falsely negative ultrasound assessments are therefore not excluded and could have led to overrated negative predictive values for fetal ultrasound. This study was initiated 20 years ago, the knowledge about cytomegalovirus infection, its natural history during pregnancy, and available tools for prenatal risk stratification were limited, compared with actual management options. In 1996, patients with first-trimester primary cytomegalovirus infection and proven fetal infection based on amniotic fluid analysis were considered to be at high risk for severe neurologic postnatal impairments. Therefore, management options that included pregnancy termination, even for cases with negative fetal ultrasound results, were discussed with patients. Important progress has been made. Risk for fetal neurologic impairments can be stratified with the use of noninvasive techniques like magnetic resonance imaging analysis with improved sensitivity and sensibility when compared with fetal ultrasound scanning.1 This was implemented in our clinical practice with fewer indications for terminations. Nevertheless, discussions about prognosis and cytomegalovirus-related postnatal sequelae remain difficult. Counseling should include a broader clinical approach with a more extended screening for adverse outcomes. Ophthalmologic cytomegalovirus complications are clearly underestimated2 as is long-term progressive hearing deterioration that has been noted in 18–62% of all children with sensorineural hearing loss at birth.3 Both could lead to cytomegalovirus-related neurodevelopmental impairments without adequate identification and management.

Jaar van publicatie:2017

Trefwoorden:children, Primary maternal cytomegalovirus infections

CSS-citation score:1

Toegankelijkheid:Open