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Wade CA, Atkinson N, Holmes NE, Hui L. Clinical utility of maternal TORCH screening in fetal growth restriction: A retrospective two-centre study. Aust N Z J Obstet Gynaecol 2024. [PMID: 38380539 DOI: 10.1111/ajo.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/28/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the indications for maternal TORCH (Toxoplasma gondii, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV)) serology, with a focus on the yield in isolated fetal growth restriction (FGR). MATERIALS AND METHODS A retrospective review of antenatal TORCH testing between January 2014 and December 2018 was carried out at two hospitals in Melbourne, Australia. TORCH testing ordered for pregnancy losses and stillbirth was excluded. RESULTS Medical records of 718 pregnancies were reviewed, representing 760 fetuses. Isolated FGR was the indication for TORCH screening in 71.2% of pregnancies. Screens ordered for isolated FGR were positive in 7.4% (95% CI 5.5-10.0%). There were 49 positive maternal immunoglobulin M (CMV = 34, Toxoplasma = 15). Two acute maternal infections during pregnancy were diagnosed (CMV = 1, Toxoplasma = 1), with both screens ordered to assess symptomatic maternal illness. There was one neonatal CMV infection, born to a woman with symptomatic primary CMV. No maternal or neonatal rubella or HSV infections were identified. We found a diagnostic yield of TORCH screening for isolated FGR of 0.0% (95% CI 0.00-0.8%). An estimated AUD$64 269.75 was expended on maternal TORCH screens in this study. CONCLUSION Maternal TORCH testing for isolated FGR is of no diagnostic yield and should be abandoned.
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Affiliation(s)
- Christine A Wade
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Northern Health, Melbourne, Victoria, Australia
| | - Naomi Atkinson
- Department of Obstetrics and Gynaecology, Northern Health, Melbourne, Victoria, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, Northern Health, Melbourne, Victoria, Australia
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Abu Shqara R, Or S, Abu Zraki A, Rizik J, Glikman D, Rechnitzer H, Lowenstein L, Frank Wolf M. The Utility of Maternal TORCH Screening Due to Obstetrical Indications in Detecting Congenital Infections: A Retrospective Observational Study. Pediatr Infect Dis J 2024; 43:69-73. [PMID: 37725823 DOI: 10.1097/inf.0000000000004107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND The diagnostic yield of TORCH screening for obstetrical indications is unclear. We evaluated TORCH testing results among women with intrauterine growth restriction (IUGR), polyhydramnios and oligohydramnios; and associations with congenital infections in neonates. METHOD This retrospective single-center study included all the women diagnosed with IUGR, polyhydramnios or oligohydramnios who underwent serological TORCH testing during 2010-2019. TORCH screening included Toxoplasma, cytomegalovirus (CMV), rubella IgM and IgG. The data, which were cross-referenced with data of neonates with congenital TORCH infections during the same period, included indications for neonatal testing, sonographic findings and neonatal ophthalmologic and hearing findings. RESULT Six women of 771 (0.8%) were diagnosed with primary TORCH infection: 4 (0.5%) with toxoplasmosis, and 2 (0.3%) with CMV. None had a confirmed congenital infection. The rates of positive maternal TORCH screening in IUGR and polyhydramnios were 2.1% and 0.6%, respectively. Maternal TORCH infection was not identified in any woman with oligohydramnios or severe polyhydramnios. None of the neonates with congenital infection were screened for TORCH during pregnancy due to polyhydramnios, oligohydramnios or IUGR. Among the neonates with congenital CMV, the most common indication for performing neonatal CMV polymerase chain reaction was suspected primary maternal infection during pregnancy due to symptomatic CMV. No incidences of congenital rubella were noted in the last decade in our medical center. CONCLUSION Our results suggest that routine TORCH screening in pregnancies complicated with IUGR, polyhydramnios or oligohydramnios should be avoided. Suggestive maternal symptoms and specific fetal sonographic features should prompt testing for CMV and Toxoplasma infection.
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Affiliation(s)
- Raneen Abu Shqara
- From the Obstetrics and Gynecology department, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Shany Or
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Abdallah Abu Zraki
- From the Obstetrics and Gynecology department, Galilee Medical Center, Nahariya, Israel
| | - Jeries Rizik
- From the Obstetrics and Gynecology department, Galilee Medical Center, Nahariya, Israel
| | - Daniel Glikman
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Hagai Rechnitzer
- From the Obstetrics and Gynecology department, Galilee Medical Center, Nahariya, Israel
| | - Lior Lowenstein
- From the Obstetrics and Gynecology department, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- From the Obstetrics and Gynecology department, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Huri M, Di Tommaso M, Seravalli V. Amniotic Fluid Disorders: From Prenatal Management to Neonatal Outcomes. CHILDREN 2023; 10:children10030561. [PMID: 36980117 PMCID: PMC10047002 DOI: 10.3390/children10030561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
Amniotic fluid volume assessment has become standard in the surveillance of fetal well-being, especially in high-risk pregnancies. Amniotic fluid disorders are a frequent and important topic in fetal and perinatal medicine. However, although important advances have been achieved, many important and challenging questions remain unanswered to date. An abnormally low amniotic fluid volume, referred to as oligohydramnios, has been traditionally considered a possible indicator of placental insufficiency or fetal compromise and is associated with an increased rate of obstetric interventions. An excess of amniotic fluid, referred to as polyhydramnios, may be secondary to fetal or maternal conditions and has been associated with a variety of adverse pregnancy outcomes, especially when it is severe. The ultrasonographic detection of an amniotic fluid disorder should prompt a proper workup to identify the underlying etiology. Data on the association of isolated oligohydramnios or idiopathic polyhydramnios with adverse obstetric and perinatal outcomes are conflicting. While the management of secondary oligohydramnios is usually guided by the underlying condition, the management of isolated oligohydramnios is poorly defined. Similarly, the management of idiopathic and secondary polyhydramnios is not yet standardized. There is an urgent need for randomized clinical trials to provide stronger recommendations on the management of these two common conditions.
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Moya-Salazar J, SantaMaria BM, Moya-Salazar MM, Rojas-Zumaran V, Chicoma-Flores K, Contreras-Pulache H. Six-sigma and quality planning of TORCH tests in the Peruvian population: a single-center cross-sectional study. BMC Res Notes 2022; 15:16. [PMID: 35016699 PMCID: PMC8753838 DOI: 10.1186/s13104-022-05904-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/31/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To ensure the health of newborns, it is necessary to perform high-quality diagnostic tests. The TORCH panel is a set of tests that identifies infectious pathogens such as Toxoplasma (Toxo) and Cytomegalovirus (CMV) that are common in low-setting populations. We performed TORCH panel quality planning using six sigma in a reference laboratory at Peru. Results This was a cross-sectional study. TORCH tests include Toxo, Rubella, CMV, and Herpes. We processed all samples by fourth-generation ELISA on the GEMINI XCR200 analyzer (Diatron, Budapest, Hungary). We obtained the imprecision from the annual data of the external quality assessment plan and we used the CLSI EP12-A3 guideline. In a total of 44,788 analyses, the average imprecision was 3.69 ± 1.47%, and CMV had lower imprecision (2.3 and 2.6% for IgM and IgG, respectively). Quality planning of the TORCH panel allowed estimating the sigma value that ranged from 4 to 10 (average 7 ± 2 sigma), where rubella had the highest values (10 for IgM and 8 for IgG) while HSV2 had the lowest values (4 for IgM and 5 for IgG). Our results suggest the optimal performance of half of the markers including Toxoplasma, Rubella, and CMV in the Peruvian population.
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Affiliation(s)
- Jeel Moya-Salazar
- Department of Pathology, Hospital Nacional Docente Madre-Niño San Bartolomé, Lima, Peru.,Faculties of Health Science, School of Medicine, Universidad Norbert Wiener, 444 Arequipa Av., 51001, Lima, Peru
| | - Bianca M SantaMaria
- Faculties of Health Science, School of Medical Technology, Universidad Norbert Wiener, Lima, Peru.,Clinical and Laboratory Department, Suiza Lab, Lima, Peru
| | | | - Víctor Rojas-Zumaran
- Department of Pathology, Hospital Nacional Docente Madre-Niño San Bartolomé, Lima, Peru
| | - Karina Chicoma-Flores
- South America Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Peru
| | - Hans Contreras-Pulache
- Faculties of Health Science, School of Medicine, Universidad Norbert Wiener, 444 Arequipa Av., 51001, Lima, Peru. .,South America Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Peru.
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5
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Fitzpatrick D, Holmes NE, Hui L. A systematic review of maternal TORCH serology as a screen for suspected fetal infection. Prenat Diagn 2021; 42:87-96. [PMID: 34893980 DOI: 10.1002/pd.6073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The acronym 'TORCH' refers to well-recognised causes of perinatal infections: toxoplasmosis, rubella, cytomegalovirus (CMV) and herpes simplex virus (HSV). A TORCH serology panel is often used to test for maternal primary infection following detection of ultrasound abnormalities in pregnancy. AIM This review aims to estimate the diagnostic yield of maternal TORCH serology in pregnancy following fetal ultrasound abnormalities. MATERIALS AND METHODS Primary studies published since 2000 that assessed maternal TORCH serology for suspected fetal infection and included information on indications for testing, definition of positive TORCH serology results, and perinatal outcomes were included. RESULTS Eight studies with a total of 2538 pregnancies were included. The main indications for testing were polyhydramnios, fetal growth restriction and hyperechogenic bowel. There were 26 confirmed cases of congenital CMV, of which 15 had multiple ultrasound abnormalities. There were no cases of congenital toxoplasmosis, rubella or HSV confirmed in any of the eight studies. CONCLUSIONS The clinical utility of TORCH serology for non-specific ultrasound abnormalities such as isolated fetal growth restriction or isolated polyhydramnios is low. It is time to retire the TORCH acronym and the reflex ordering of 'TORCH' panels, as their continued use obscures, rather than illuminates, appropriate investigation for fetal ultrasound abnormalities.
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Affiliation(s)
- Danielle Fitzpatrick
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Natasha E Holmes
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Lisa Hui
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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Guo D, He D, Shen Q, Lin N, He S, Dai Y, Li Y, Xu L, Wu X. Comprehensive Assessment of Fetal Bilateral Ventriculomegaly Based on Genetic Disorders, Cytomegalovirus Infection, Extra Prenatal Imaging and Pregnancy Outcomes in a Tertiary Referral Center. Int J Gen Med 2021; 14:7719-7728. [PMID: 34764685 PMCID: PMC8577530 DOI: 10.2147/ijgm.s335011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This retrospective study aimed to systematically evaluate the genetic disorders, cytomegalovirus (CMV) infection, extra ultrasound findings and outcomes of fetuses with bilateral ventriculomegaly (BVM). Methods Data from pregnancies with fetal BVM were obtained between 2014 and 2020. The cases were divided into groups of isolated bilateral ventriculomegaly (IBVM) and non-isolated bilateral ventriculomegaly (NIBVM) according to the presence of extra prenatal imaging. Subgroups of mild, moderate, and severe were determined according to lateral ventricle widths. The NIBVM group was further classified into pregnancies with soft markers, non-structural abnormalities, and structural abnormalities. Results A total of 353 pregnancies were enrolled, including 153 cases of IBVM and 200 cases of NIBVM. Conventional karyotyping was performed on 192 samples, and 15 cases of numerical abnormalities and 3 cases of unbalanced structural abnormalities were identified. Chromosomal microarray analysis (CMA) was concurrently performed on 108 of them and revealed additional 5 cases (4.7%) of copy number variants with clinical significance. CMV DNA testing was performed on 154 of the 192 cases that underwent invasive prenatal diagnosis, and a positive result was found in 2 (1.3%) cases. In the IBVM group, the percentage of favorable prognosis in the mild, moderate and severe pregnancies were 94.4%, 79.2%, and 4.8%, respectively, and the termination of pregnancy (TOP) rates were 4.6%, 20.8%, and 85.7%, respectively. In both the mild and moderate NIBVM, the TOP rates progressively increased and the favorable prognosis survival rates progressively decreased relative to the soft markers, non-structural abnormalities, and structural abnormalities, respectively. Approximately 94.1% of severe NIBVM ended in termination. Conclusion Genetic disorders and fetal infection are important etiology of BVM. CMA is highly recommended for genetic disorders’ evaluation. Pregnancies with severe BVM always ended in TOP, while in mild-to-moderate NIBVM, prenatal imaging by ultrasound and/or MRI plays important roles in the pregnancy outcomes.
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Affiliation(s)
- Danhua Guo
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Deqin He
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Qingmei Shen
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Na Lin
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Shuqiong He
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Yifang Dai
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Ying Li
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Liangpu Xu
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China
| | - Xiaoqing Wu
- Medical Genetic Diagnosis and Therapy Center of Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou City, Fujian Province, People's Republic of China.,Department of Laboratory Medicine, Fujian Medical University, Fuzhou, 350002, Fujian, People's Republic of China
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7
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Unterscheider J, Cuzzilla R. Severe early-onset fetal growth restriction: What do we tell the prospective parents? Prenat Diagn 2021; 41:1363-1371. [PMID: 34390005 DOI: 10.1002/pd.6030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 11/09/2022]
Abstract
Fetal growth restriction (FGR) is a common complication of pregnancy, associated with higher risk of perinatal mortality and adverse health and developmental outcomes for surviving infants. True FGR relates to a pathological restriction of fetal growth resulting from complex interactions between maternal, placental, fetal, and environmental factors. Early-onset FGR (onset <32 weeks' gestation) is often first suspected at routine mid-trimester sonographic assessment of fetal morphology, or identified as part of the placental syndrome, commonly maternal pre-eclampsia. Prenatal investigations may identify the cause of FGR. Timing of delivery is guided by serial sonographic surveillance of fetal growth and well-being and maternal condition, balancing the risk of stillbirth with the benefits of advancing gestation. This is particularly pertinent to severe early-onset FGR, a leading iatrogenic cause of very preterm birth. Prognosis is largely determined by the severity of FGR and its causes, gestation at birth, and birthweight. Pregnancy termination may be considered. Antenatal care and delivery in a tertiary center, provided by a multi-disciplinary team with expertise in managing high-risk pregnancies, are imperative to optimizing outcomes.
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Affiliation(s)
- Julia Unterscheider
- Department of Maternal Fetal Medicine, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rocco Cuzzilla
- Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Victoria, Australia.,Neonatal Services and Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
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8
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Çoşkun B, Gülümser Ç, Çoşkun B, Artuk C, Karaşahin KE. Impact of Syrian refugees on congenital TORCH infections screening in Turkey. J Obstet Gynaecol Res 2020; 46:1017-1024. [PMID: 32343041 DOI: 10.1111/jog.14273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/23/2020] [Accepted: 03/15/2020] [Indexed: 11/27/2022]
Abstract
AIM To demonstrate the effect of the Syrian refugee population on the prevalence of congenital TORCH (Toxoplasmosis, Other [syphilis, varicella-zoster, parvovirus B19], Rubella, Cytomegalovirus [CMV] and Herpes) infections and to evaluate the cost-effectiveness of population-based TORCH screening during pregnancy in Turkey. METHODS Pregnant women (n = 9754) were enrolled. Ultrasonographic findings, immunoglobulin (Ig)M and IgG seropositivity, avidity, amniocentesis and DNA-polymerase chain reaction (PCR) results were compared. Costs were calculated based on invoice amounts from the Health Applications Communique pricing system. RESULTS The prevalence of TORCH seropositivity in Turkey was not significantly different between all regions (P > 0.05). Overall, 1333 (13.67%) pregnant Syrian refugees were included in the study. Acute CMV, rubella and Toxoplasma gondii infections (according to low IgG avidity in IgM positive patients) were detected in 17.82%, 21.53% and 14.07% of women, respectively. Twenty-four women underwent an amniocentesis procedure and nine of them had positive DNA-PCR and reverse transcription-PCR results. All women with positive results opted to terminate the pregnancy. There was no statistical difference among groups according to the rate of low IgG avidity in IgM-positive patients and termination rates for T. gondii, rubella and CMV (P > 0.05). Total cost for screening the entire study population was presented in US dollars (USD). A total of 71 529 and prenatal diagnosis with positive invasive test results were obtained in nine women: toxoplasmosis in four, CMV in three and rubella in two women. CONCLUSION Population-based screening for prenatal TORCH infections is not cost-effective in Turkey. Syrian refugees have a limited effect on the increasing prevalence of congenital TORCH infections.
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Affiliation(s)
- Bora Çoşkun
- Department of Obstetrics and Gynecology, Yuksek Ihtisas University School of Medicine Ankara Liv Hospital, Ankara, Turkey
| | - Çağrı Gülümser
- Department of Obstetrics and Gynecology, University of Health Science School of Medicine, Ankara, Turkey
| | - Buğra Çoşkun
- Department of Infectious Diseases and Clinical Microbiology, SBÜ Gülhane Education and Research Hospital, Ankara, Turkey
| | - Cumhur Artuk
- Department of Obstetrics and Gynecology, SBÜ Gülhane Education and Research Hospital, Ankara, Turkey
| | - Kazım E Karaşahin
- Department of Obstetrics and Gynecology, SBÜ Gülhane Education and Research Hospital, Ankara, Turkey
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Tomic K, Schönberger H, Weber P, Lapaire O, Manegold-Brauer G. Significance of isolated borderline ventriculomegaly. Childs Nerv Syst 2020; 36:393-399. [PMID: 31079183 DOI: 10.1007/s00381-019-04189-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/30/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Foetal ventriculomegaly (VM) is one of the most commonly diagnosed brain abnormalities. The aims of this study were to assess cases with isolated VM, describe the prenatal course and assess short- and long-term follow-up at the age of 2 years. METHODS We performed a retrospective analysis from our prenatal data base and included all children that were prenatally diagnosed with VM in our unit between 2008 and 2013 (n = 250). Prenatal management, postnatal outcome and neurologic development at the age of 2 years were evaluated. RESULTS A total of 106 children were born at our institution and were diagnosed prenatally with isolated borderline VM. A total of 1.9% (n = 2/106) was transferred to the neonatal unit. A total of 0.9% (n = 1/106) showed abnormal findings in postnatal brain ultrasound. A total of 1.9% (n = 2/106) showed mild neurologic abnormalities after birth, but none had to be seen by a neuropediatrician. At the follow-up at 2 years, 2.5% (n = 1/40) had an insertion of a shunt. CONCLUSION Based on our analysis, the majority of isolated borderline VM do not show short- or long-term neurological abnormalities. However, all cases of VM should be referred to a detailed prenatal ultrasound exam by a specialist.
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Affiliation(s)
- Katrin Tomic
- Division of Prenatal Diagnostics and Gynecologic Ultrasound, Women's Hospital, Basel University Hospital, Basel, Switzerland
| | - Heidrun Schönberger
- Division of Prenatal Diagnostics and Gynecologic Ultrasound, Women's Hospital, Basel University Hospital, Basel, Switzerland
| | - Peter Weber
- Division of Neuro- and Developmental Paediatrics, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Olav Lapaire
- Division of Prenatal Diagnostics and Gynecologic Ultrasound, Women's Hospital, Basel University Hospital, Basel, Switzerland
| | - Gwendolin Manegold-Brauer
- Division of Prenatal Diagnostics and Gynecologic Ultrasound, Women's Hospital, Basel University Hospital, Basel, Switzerland.
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10
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Yefet E, Ben Shmuel Y, Nachum Z. The association between polyhydramnios and CMV infection - retrospective cohort study. J Matern Fetal Neonatal Med 2019; 34:3716-3722. [PMID: 31698981 DOI: 10.1080/14767058.2019.1691164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Polyhydramnios was suggested to be associated with CMV infection, resulting in polyhydramnios being common indication for CMV testing. However, the literature does not provide a robust evidence to support this management. We aimed to examine the association between congenital CMV infection and polyhydramnios.Methods: A retrospective cohort study was conducted. The rate of polyhydramnios was analyzed in 63 neonates/fetuses with CMV between 2013 and 2017 and compared to 351 neonates without CMV using PCR targeted to the viral DNA. The rate of oligohydramnios and small for gestational age was also evaluated.Results: All cases of polyhydramnios were of isolated polyhydramnios without malformations. The rate of polyhydramnios was six (9.5%) and 23 (6.6%) pregnancies with and without congenital CMV, respectively (p = .42). Persistent polyhydramnios (more than one documented event) was evident in one (1.6%) and 13 (3.7%) pregnancies in the positive and negative CMV groups, respectively (p = .36). The rate of congenital CMV was similar with and without oligohydramnios (6, 9.5% versus 17, 4.8%, respectively; p = .14) and with or without small for gestational age neonate (7, 11% versus 63, 18%, respectively; p = .18).Conclusion: The results of this study do not support an association between CMV infection and polyhydramnios. The need for CMV testing in isolated polyhydramnios should be reevaluated.
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Affiliation(s)
- Enav Yefet
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Department of Obstetrics and Gynecology, Baruch Padeh Medical Center Poriya, Tiberias, Israel.,Faculty of Medicine in Galilee, Bar-Ilan University, Safed, Israel
| | - Yair Ben Shmuel
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Zohar Nachum
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
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11
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Désilets V, De Bie I, Audibert F. No. 363-Investigation and Management of Non-immune Fetal Hydrops. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:1077-1090. [PMID: 30103882 DOI: 10.1016/j.jogc.2017.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To describe the current investigation and management of non-immune fetal hydrops with a focus on treatable or recurring etiologies. OUTCOMES To provide better counselling and management in cases of prenatally diagnosed non-immune hydrops. EVIDENCE Published literature was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library in 2017 using key words (non-immune hydrops fetalis, fetal hydrops, fetal therapy, fetal metabolism). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, observational studies, and significant case reports. Additional publications were identified from the bibliographies of these articles. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2017. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinicalpractice guideline collections, clinical trial registries, and national and international medical specialty societies. BENEFITS, HARMS, AND COSTS These guidelines educate readers about the causes of non-immune fetal hydrops and its prenatal counselling and management. It also provides a standardized approach to non-immune fetal hydrops, emphasizing the search for prenatally treatable conditions and recurrent genetic etiologies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. RECOMMENDATIONS
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12
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Hwang JS, Friedlander S, Rehan VK, Zangwill KM. Diagnosis of congenital/perinatal infections by neonatologists: a national survey. J Perinatol 2019; 39:690-696. [PMID: 30914779 DOI: 10.1038/s41372-019-0364-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/20/2019] [Accepted: 03/05/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the clinical approach used by neonatologists for diagnosis of congenital/perinatal infections (CPI); no such data currently exist. STUDY DESIGN A national survey regarding the diagnosis of toxoplasma, syphilis, rubella, cytomegalovirus, and herpes simplex virus (HSV) infection in neonates. RESULT We received 553 (11%) responses. Central nervous system calcification or hydrocephalus was the commonest trigger to pursue a CPI diagnosis (98%); maternal history was the least frequent (67%). Four hundred twenty-two (76%) used general screening such as "TORCH titer screen" (57%) or total IgG or IgM (39%). Further evaluation targeted known clinical sequelae; but cerebrospinal fluid testing was used in only 65% of those suspected of having HSV or syphilis. Fifty-six percent chose a treponemal instead of a non-treponemal test for syphilis. Multivariable analyses did not identify factors associated with the clinical diagnostic approach. CONCLUSION We observed clinically important deviations from CPI diagnostic test recommendations in a national cohort of neonatologists.
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Affiliation(s)
- Jung S Hwang
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Scott Friedlander
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Virender K Rehan
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA.,Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kenneth M Zangwill
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA. .,Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA.
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Désilets V, De Bie I, Audibert F. N° 363 - Évaluation et prise en charge de l'anasarque fœtoplacentaire non immune. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1091-1107. [PMID: 29980442 DOI: 10.1016/j.jogc.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIF Décrire les méthodes actuelles d'évaluation et de prise en charge de l'anasarque fœtoplacentaire non immune en mettant l'accent sur les étiologies traitables ou récurrentes. RéSULTATS: Offrir de meilleurs services de conseil et de prise en charge en cas d'anasarque fœtoplacentaire non immune diagnostiquée en période prénatale. DONNéES: La littérature publiée a été récupérée au moyen de recherches menées dans PubMed, MEDLINE, CINAHL, et la Bibliothèque Cochrane en 2017 à l'aide de mots-clés (« non-immune hydrops fetalis », « fetal hydrops », « fetal therapy », « fetal metabolism »). Les articles retenus portaient sur des revues systématiques, des essais cliniques contrôlés, randomisés ou non, des études observationnelles et des études de cas importantes. D'autres publications ont été repérées dans les bibliographies de ces articles. Aucune restriction de date ou de langue n'a été employée. Les recherches ont été mis à jour régulièrement, et les résultats ont été incorporés à la directive clinique jusqu'en septembre 2017. Nous avons également tenu compte de la littérature grise (non publiée) trouvée sur les sites Web d'organismes d'évaluation des technologies de la santé et d'autres organismes liés aux technologies de la santé, dans des collections de directives cliniques et des registres d'essais cliniques, et obtenue auprès d'associations nationales et internationales de médecins spécialistes. AVANTAGES, INCONVéNIENTS ET COûTS: La présente directive clinique renseigne les lecteurs sur les causes de l'anasarque fœtoplacentaire non immune ainsi que sur son évaluation et sa prise en charge. Elle propose également une approche standardisée d'évaluation et de prise en charge, et met l'accent sur la recherche des conditions traitables en période prénatale et des étiologies génétiques récurrentes. VALEURS La qualité des données probantes a été évaluée en fonction des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs. RECOMMANDATIONS.
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Key Words
- ACM, artère cérébrale moyenne
- ADN, acide désoxyribonucléique
- AFNI, anasarque fœtoplacentaire non immune
- AG, âge gestationnel
- CMV, cytomégalovirus
- ELISA, essai immuno-enzymatique
- FISH, hybridation in situ fluorescente
- FSC, formule sanguine complète
- Hb H, hémoglobine H
- Hb, hémoglobine
- IgG, immunoglobuline G
- IgM, immunoglobuline M
- MPS, mucopolysaccharidose
- QF-PCR, réaction en chaîne par polymérase fluorescente quantitative
- RT-PCR, réaction en chaîne par polymérase en temps réel
- SOGC, Société des obstétriciens et gynécologues du Canada
- TORCH, toxoplasmose, rubéole, cytomégalovirus, herpès simplex
- VIH, virus de l'immunodéficience humaine
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Chung MH, Shin CO, Lee J. TORCH (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus) screening of small for gestational age and intrauterine growth restricted neonates: efficacy study in a single institute in Korea. KOREAN JOURNAL OF PEDIATRICS 2018; 61:114-120. [PMID: 29713357 PMCID: PMC5924842 DOI: 10.3345/kjp.2018.61.4.114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/16/2017] [Accepted: 10/31/2017] [Indexed: 11/27/2022]
Abstract
Purpose Routine screening for toxoplasmosis, rubella, cytomegalovirus (CMV), and herpes simplex virus (TORCH) in intrauterine growth restriction (IUGR) and small for gestational age (SGA) neonates has become a common practice. However, the incidence of TORCH varies across countries, and the cost of TORCH testing may be disadvantageous compared to disease-specific screening. To evaluate the efficacy of TORCH screening, the medical charts of IUGR or SGA neonates born in a single institution in Bucheon, Korea from 2011 to 2015 were reviewed. Methods The clinical data of the 126 IUGR or SGA neonates were gathered, including gestational age, Apgar scores, neonatal sonographic findings, chromosome study, morbidities, developmental follow-up, and growth catch-up. Maternal factors including underlying maternal disease and fetal sonography were collected, and placental findings were recorded when available. TORCH screening was done using serum IgM, CMV urine culture, quantification of CMV DNA with real-time polymerase chain reaction, and rapid plasma reagin qualitative test for syphilis. Tests were repeated only for those with positive results. Results Of the 119 TORCH screenings, only one was positive for toxoplasmosis IgM. This result was deemed false positive due to negative IgM on repeated testing and the absence of clinical symptoms. Conclusion Considering the incidence and risk of TORCH in Korea, the financial burden of TORCH screening, and the single positive TORCH finding in our study, we suggest disease-specific screening based on maternal history and the clinical symptoms of the neonate. Regarding CMV, which may present asymptomatically, universal screening may be appropriate upon cost-benefit analysis.
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Affiliation(s)
- Mi Hae Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Ok Shin
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Juyoung Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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15
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Rafi J. Re: Utility of routine urine CMV PCR and total serum IgM testing of small for gestational age infants: a single center review. J Perinat Med 2018; 46:233. [PMID: 29031021 DOI: 10.1515/jpm-2017-0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/11/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Junaid Rafi
- Ipswich Hospital NHS Trust, Heath Road, Ipswich, IP4 5PD, UK
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16
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Espiritu MM, Bailey S, Wachtel EV, Mally PV. Utility of routine urine CMV PCR and total serum IgM testing of small for gestational age infants: a single center review. J Perinat Med 2018; 46:81-86. [PMID: 28803228 DOI: 10.1515/jpm-2016-0287] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 07/17/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Due to the extremely low incidence of TORCH (toxoplasmosis, rubella, CMV, herpes simplex virus) infections, diagnostic testing of all small for gestational age (SGA) infants aimed at TORCH etiologies may incur unnecessary tests and cost. OBJECTIVE To determine the frequency of urine CMV PCR and total IgM testing among infants with birth weight <10% and the rate of test positivity. To evaluate the frequency of alternative etiologies of SGA in tested infants. METHODS Retrospective chart review of SGA infants admitted to the neonatal intensive care unit (NICU) at NYU Langone Medical Center between 2007 and 2012. Subjects were classified as being SGA with or without intrauterine growth restriction (IUGR). The IUGR subjects were then further categorized as having either symmetric or asymmetric IUGR utilizing the Fenton growth chart at birth. Initial testing for TORCH infections, which included serum total IgM, CMV PCR and head ultrasound, were reviewed and analyzed. RESULTS Three hundred and eighty-six (13%) infants from a total of 2953 NICU admissions had a birth weight ≤10th percentile. Of these, 44% were IUGR; 34% being symmetric IUGR and 10% asymmetric. A total of 32% of SGA infants had urine CMV PCR and total IgM tested with no positive results. As expected, significantly higher percentage of symmetric IUGR infants were tested compared to asymmetric IUGR and non-IUGR SGA infants, (64% vs. 47% vs. 19%) P≤0.01. However, 63% of infants with a known cause for IUGR had same testing done aimed at TORCH infections. We calculated additional charges of $64,065 that were incurred by such testing. CONCLUSIONS The majority of infants in our study who received testing for urine CMV PCR and total IgM aimed at TORCH infections had one or more other known non-infectious etiologies for IUGR. Because the overall yield of such testing is extremely low, we suggest tests for possible TORCH infections may be limited to symmetric IUGR infants without other known etiologies. Improved guidelines testing for TORCH infections can result in reducing hospital charges and unnecessary studies.
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Affiliation(s)
- Michael M Espiritu
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, 317 E 34th Street, Suite 902, New York, NY 10016, USA
| | - Sean Bailey
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, New York, NY 10016, USA
| | - Elena V Wachtel
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, New York, NY 10016, USA
| | - Pradeep V Mally
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, New York, NY 10016, USA
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17
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Findley R, Allen VM, Brock JAK. Adverse Perinatal Conditions Associated With Prenatally Detected Fetal Echogenic Bowel in Nova Scotia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:555-560. [PMID: 29274932 DOI: 10.1016/j.jogc.2017.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study sought to estimate the association of adverse perinatal outcomes with pregnancies complicated by fetal echogenic bowel. METHODS Data for pregnancies complicated with echogenic bowel identified in the second trimester were derived from the tertiary referral IWK Health Centre (Halifax, NS) Viewpoint Ultrasound Database augmented by medical chart review. The study was undertaken between 2003 and 2014. Rates of positive cytomegalovirus and toxoplasmosis infection were determined using maternal serology and amniocentesis results. Rates of intrauterine growth restriction, abnormal karyotype, cystic fibrosis, antenatal bleeding, and bowel abnormalities were also determined. Neonatal information included newborn urine culture results and postnatal genetic testing. Univariate analyses compared rates of infection with isolated echogenic bowel and echogenic bowel with other ultrasound findings, with statistical significance set at P <0.05. RESULTS There were 422 pregnancies identified prenatally with echogenic bowel (82% had isolated echogenic bowel). Of these, 92 (22%) had at least one of the foregoing associated abnormalities. Three percent of women had serologic test results positive for cytomegalovirus or toxoplasmosis, with <1% documented newborn infections. Cystic fibrosis and other genetic diagnoses were observed in 8%, intrauterine growth restriction in 14%, antenatal bleeding in 19%, and bowel abnormalities in 3% of the cases of echogenic bowel. Pregnancies with isolated echogenic bowel had an 80% reduction in risk for these significant outcomes, in contrast to a four- to 11-fold increased risk of specific outcomes when additional ultrasound findings were present. CONCLUSION An overall rate of adverse conditions of 22% with prenatally detected echogenic bowel serves to inform women and health care providers and emphasizes the importance of careful screening fetal ultrasound studies and timely referral for comprehensive assessment with findings of echogenic bowel for evaluation for associated findings.
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Affiliation(s)
- Rachelle Findley
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS
| | - Victoria M Allen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS
| | - Jo-Ann K Brock
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS; Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS.
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18
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Lausman A, Kingdom J. Retard de croissance intra-utérin : Dépistage, diagnostic et prise en charge. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S277-S286. [PMID: 28063541 DOI: 10.1016/j.jogc.2016.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Désilets V, Audibert F. Exploration et prise en charge de l'anasarque fœtoplacentaire non immune. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S311-S325. [PMID: 28063543 DOI: 10.1016/j.jogc.2016.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Pasquini L, Seravalli V, Sisti G, Battaglini C, Nepi F, Pelagalli R, Di Tommaso M. Prevalence of a positive TORCH and parvovirus B19 screening in pregnancies complicated by polyhydramnios. Prenat Diagn 2016; 36:290-3. [DOI: 10.1002/pd.4769] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 11/25/2015] [Accepted: 12/30/2015] [Indexed: 11/12/2022]
Affiliation(s)
- L. Pasquini
- Department of Health Sciences; University of Florence; Florence Italy
| | - V. Seravalli
- Department of Health Sciences; University of Florence; Florence Italy
| | - G. Sisti
- Department of Health Sciences; University of Florence; Florence Italy
| | - C. Battaglini
- Department of Health Sciences; University of Florence; Florence Italy
| | - F. Nepi
- Department of Health Sciences; University of Florence; Florence Italy
| | - R. Pelagalli
- Department of Health Sciences; University of Florence; Florence Italy
| | - M. Di Tommaso
- Department of Health Sciences; University of Florence; Florence Italy
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21
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TORCH seroprevalence among patients attending Obstetric Care Clinic of Haydarpasa Training and Research Hospital affiliated to Association of Istanbul Northern Anatolia Public Hospitals. North Clin Istanb 2015; 2:203-209. [PMID: 28058368 PMCID: PMC5175107 DOI: 10.14744/nci.2015.55376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 12/08/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Toxoplasma gondii, Rubella, Cytomegalovirus and Herpes simplex viruses are microorganisms that cause congenital infections and they are called briefly as TORCH. There is an ongoing argument for the screening of reproductive age women due to the high cost of tests. For a test to be used in screening, prevalence of disease in this population should be known. The aim of this study was to investigate TORCH seroprevalence among women attending a teaching hospital in Istanbul. METHODS A total of 1101 patients attending outpatient clinic of Obstetric Care Clinic of Haydarpasa Training and Research Hospital affiliated to Association of Istanbul Northern Anatolia Public Hospitals between September 2013 to January 2015 and their laboratory data were evaluated retrospectively. We investigated Ig G and M seropositivity rates against TORCH. RESULTS The age of the patients ranged between 17-47 years with a mean age of 30.3±5.8 years. Pregnant population had 99.5% anti-CMV Ig G (+), 94.2% anti-Rubella Ig G (+), 31% anti-Toxoplasma Ig G (+). Seroprevalence for Anti IgM was 0.5% for CMV, 0.2% for rubella. CONCLUSION The screening for Toxoplasma gondii may be suggested since the prevalence is not high in our population. The screening of CMV is not meaningful, due to high seroprevalence. Although seroprevalence of rubella is also high, it may be suggested for preconception vaccination especially in women above 20 years of age born prior to National Vaccination Programme.
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22
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Naing ZW, Scott GM, Shand A, Hamilton ST, van Zuylen WJ, Basha J, Hall B, Craig ME, Rawlinson WD. Congenital cytomegalovirus infection in pregnancy: a review of prevalence, clinical features, diagnosis and prevention. Aust N Z J Obstet Gynaecol 2015; 56:9-18. [PMID: 26391432 DOI: 10.1111/ajo.12408] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/17/2015] [Indexed: 11/30/2022]
Abstract
Human cytomegalovirus (CMV) is under-recognised, despite being the leading infectious cause of congenital malformation, affecting ~0.3% of Australian live births. Approximately 11% of infants born with congenital CMV infection are symptomatic, resulting in clinical manifestations, including jaundice, hepatosplenomegaly, petechiae, microcephaly, intrauterine growth restriction and death. Congenital CMV infection may cause severe long-term sequelae, including progressive sensorineural hearing loss and developmental delay in 40-58% of symptomatic neonates, and ~14% of initially asymptomatic infected neonates. Up to 50% of maternal CMV infections have nonspecific clinical manifestations, and most remain undetected unless specific serological testing is undertaken. The combination of serology tests for CMV-specific IgM, IgG and IgG avidity provide improved distinction between primary and secondary maternal infections. In pregnancies with confirmed primary maternal CMV infection, amniocentesis with CMV-PCR performed on amniotic fluid, undertaken after 21-22 weeks gestation, may determine whether maternofetal virus transmission has occurred. Ultrasound and, to a lesser extent, magnetic resonance imaging are valuable tools to assess fetal structural and growth abnormalities, although the absence of fetal abnormalities does not exclude fetal damage. Diagnosis of congenital CMV infection at birth or in the first 3 weeks of an infant's life is crucial, as this should prompt interventions for prevention of delayed-onset hearing loss and neurodevelopmental delay in affected infants. Prevention strategies should also target mothers because increased awareness and hygiene measures may reduce maternal infection. Recognition of the importance of CMV in pregnancy and in neonates is increasingly needed, particularly as therapeutic and preventive interventions expand for this serious problem.
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Affiliation(s)
- Zin W Naing
- Serology and Virology Division (SAViD), Department of Microbiology, SEALS, Prince of Wales Hospital, Randwick, Australia.,School of Medical Sciences, Faculty of Medicine, University of New South Wales, Randwick, Australia.,Australian Centre for Perinatal Science, University of New South Wales, Randwick, Australia
| | - Gillian M Scott
- Serology and Virology Division (SAViD), Department of Microbiology, SEALS, Prince of Wales Hospital, Randwick, Australia.,School of Biotechnology and Biomolecular Sciences, Faculty of Science, University of New South Wales, Randwick, Australia
| | - Antonia Shand
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, Australia
| | - Stuart T Hamilton
- Serology and Virology Division (SAViD), Department of Microbiology, SEALS, Prince of Wales Hospital, Randwick, Australia.,School of Biotechnology and Biomolecular Sciences, Faculty of Science, University of New South Wales, Randwick, Australia
| | - Wendy J van Zuylen
- Serology and Virology Division (SAViD), Department of Microbiology, SEALS, Prince of Wales Hospital, Randwick, Australia.,School of Medical Sciences, Faculty of Medicine, University of New South Wales, Randwick, Australia
| | - James Basha
- Serology and Virology Division (SAViD), Department of Microbiology, SEALS, Prince of Wales Hospital, Randwick, Australia
| | - Beverly Hall
- Serology and Virology Division (SAViD), Department of Microbiology, SEALS, Prince of Wales Hospital, Randwick, Australia
| | - Maria E Craig
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Sydney, New South Wales, Australia
| | - William D Rawlinson
- Serology and Virology Division (SAViD), Department of Microbiology, SEALS, Prince of Wales Hospital, Randwick, Australia.,School of Medical Sciences, Faculty of Medicine, University of New South Wales, Randwick, Australia.,Australian Centre for Perinatal Science, University of New South Wales, Randwick, Australia.,School of Biotechnology and Biomolecular Sciences, Faculty of Science, University of New South Wales, Randwick, Australia
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Pasquini L, Masini G, Gaini C, Franchi C, Trotta M, Dani C, Di Tommaso M. The utility of infection screening in isolated mild ventriculomegaly: an observational retrospective study on 141 fetuses. Prenat Diagn 2014; 34:1295-300. [DOI: 10.1002/pd.4470] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 07/11/2014] [Accepted: 07/24/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Lucia Pasquini
- Department of Science for Woman and Child's Health; University of Florence; Florence Italy
| | - Giulia Masini
- Department of Science for Woman and Child's Health; University of Florence; Florence Italy
| | - Claudia Gaini
- Department of Science for Woman and Child's Health; University of Florence; Florence Italy
| | - Chiara Franchi
- Department of Science for Woman and Child's Health; University of Florence; Florence Italy
| | - Michele Trotta
- Department of Critical Care Medicine and Surgery, Infectious Diseases Unit; University of Florence; Florence Italy
| | - Carlo Dani
- Department of Science for Woman and Child's Health; University of Florence; Florence Italy
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Halawa S, McDermott L, Donati M, Denbow M. TORCH screening in pregnancy. Where are we now? An audit of use in a tertiary level centre. J OBSTET GYNAECOL 2014; 34:309-12. [PMID: 24476395 DOI: 10.3109/01443615.2013.872609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This audit was performed in the obstetrics and gynaecology department of a tertiary referral hospital, to investigate the use and results of TORCH screening. St Michael's Hospital delivers approximately 6,000 women from South Bristol a year and receives tertiary referrals from the South West of England and South Wales. It was found that 739 patients over a 6-year period from April 2006 to January 2012 underwent testing. The majority's indication (21%) was polyhydramnios. Three patients had evidence of primary CMV infection in pregnancy on serology, two for fetal indications (polyhydramnios and echogenic bowel) and one following a miscarriage. There were no confirmed cases of gestational toxoplasma or rubella. Routine testing for toxoplasma and rubella infection as part of the TORCH screening in cases of fetal or obstetric abnormality should thus be discontinued in our population.
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Affiliation(s)
- S Halawa
- Department of Obstetrics and Gynaecology
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25
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Wei D, Sardesai SR, Barton L. The C in TORCH: a cost-effective alternative to screening small-for-gestational-age infants. Neonatology 2014; 106:24-9. [PMID: 24732345 DOI: 10.1159/000358867] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/16/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Infants born with birth weights under the 10th percentile for their gestational age are classified as small for gestational age (SGA). TORCH infections are reported to be associated with SGA infants. With the low incidence of infections, screening is likely to be expensive and of low utility. OBJECTIVE The objective of this study was to determine the utility and cost-effectiveness of screening SGA infants with TORCH serology titers, urine cytomegalovirus (CMV) cultures and cranial ultrasounds. METHODS A retrospective review was conducted on all infants admitted to the neonatal intensive care unit (NICU) at Los Angeles County and University of Southern California (LAC+USC) Medical Center from January 2003 to December 2011 with a diagnosis of SGA or intrauterine growth restriction. Birth characteristics such as birth weight, length, head circumference and gestational age were recorded. TORCH titer results, urine CMV results and cranial ultrasound findings were collected. RESULTS Between 2003 and 2011, 232 SGA infants were admitted to the NICU at LAC+USC Medical Center. Of these, 117 infants (50%) had TORCH titer testing performed; there was only 1 positive CMV IgM and 1 positive HSV IgM result. Repeat urine CMV testing was performed on 109 infants (47%), with a total of 296 urine CMV samples collected from these infants; 6 infants had positive results, of whom 3 had repeat positive urine CMV samples. Overall, 149 of the infants had a cranial ultrasound done, none of which were positive for calcifications. CONCLUSIONS TORCH titer testing, urine CMV screening and cranial ultrasound screening are of low yield in screening clinically asymptomatic SGA infants for TORCH infections. Given the low number of positive results, a cost-effective alternative of selective TORCH testing may be limited to infants with additional clinical findings. This study serves as a reminder to periodically examine testing practices and patient population to maximize cost-effectiveness.
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Affiliation(s)
- Daniel Wei
- Division of Neonatal Medicine, Department of Pediatrics, Los Angeles County and University of Southern California Medical Center, Los Angeles, Calif., USA
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26
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Hamza A, Herr D, Solomayer EF, Meyberg-Solomayer G. Polyhydramnios: Causes, Diagnosis and Therapy. Geburtshilfe Frauenheilkd 2013; 73:1241-1246. [PMID: 24771905 DOI: 10.1055/s-0033-1360163] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 01/08/2023] Open
Abstract
Polyhydramnios is defined as a pathological increase of amniotic fluid volume in pregnancy and is associated with increased perinatal morbidity and mortality. Common causes of polyhydramnios include gestational diabetes, fetal anomalies with disturbed fetal swallowing of amniotic fluid, fetal infections and other, rarer causes. The diagnosis is obtained by ultrasound. The prognosis of polyhydramnios depends on its cause and severity. Typical symptoms of polyhydramnios include maternal dyspnea, preterm labor, premature rupture of membranes (PPROM), abnormal fetal presentation, cord prolapse and postpartum hemorrhage. Due to its common etiology with gestational diabetes, polyhydramnios is often associated with fetal macrosomia. To prevent the above complications, there are two methods of prenatal treatment: amnioreduction and pharmacological treatment with non-steroidal anti-inflammatory drugs (NSAIDs). However, prenatal administration of NSAIDs to reduce amniotic fluid volumes has not been approved in Germany. In addition to conventional management, experimental therapies which would alter fetal diuresis are being considered.
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Affiliation(s)
- A Hamza
- Gynäkologie und Geburtshilfe, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - D Herr
- Gynäkologie und Geburtshilfe, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - E F Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - G Meyberg-Solomayer
- Gynäkologie und Geburtshilfe, Universitätsklinikum des Saarlandes, Homburg/Saar
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Salomon L, Malan V. Bilan étiologique du retard de croissance intra-utérin (RCIU). ACTA ACUST UNITED AC 2013; 42:929-40. [DOI: 10.1016/j.jgyn.2013.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Désilets V, Audibert F, Wilson R, Audibert F, Brock JA, Carroll J, Cartier L, Gagnon A, Johnson JA, Langlois S, MacDonald W, Murphy-Kaulbeck L, Okun N, Pastuck M, Senikas V. Investigation and Management of Non-immune Fetal Hydrops. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:923-38. [DOI: 10.1016/s1701-2163(15)30816-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Retard de croissance intra-utérin : Dépistage, diagnostic et prise en charge. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013. [DOI: 10.1016/s1701-2163(15)30866-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Lausman A, Kingdom J. Intrauterine growth restriction: screening, diagnosis, and management. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:741-748. [PMID: 24007710 DOI: 10.1016/s1701-2163(15)30865-3] [Citation(s) in RCA: 192] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) is an obstetrical complication, which by definition would screen in 10% of fetuses in the general population. The challenge is to identify the subset of pregnancies affected with pathological growth restriction in order to allow intervention that would decrease morbidity and mortality. OBJECTIVE The purpose of this guideline is to provide summary statements and recommendations and to establish a framework for screening, diagnosis, and management of pregnancies affected with IUGR. METHODS Affected pregnancies are compared with pregnancies in which the fetus is at an appropriate weight for its gestational age. History, physical examination, and laboratory investigations including biochemical markers and ultrasound characteristics of IUGR are reviewed, and a management strategy is suggested. EVIDENCE Published literature in English was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library in January 2013 using appropriate controlled vocabulary via MeSH terms (fetal growth restriction and small for gestational age) and key words (fetal growth, restriction, growth retardation, IUGR, low birth weight, small for gestational age). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). BENEFITS, HARMS, AND COSTS Implementation of the recommendations in this guideline should increase clinician recognition of IUGR and guide intervention where appropriate. Optimal long-term follow-up of neonates diagnosed as IUGR may improve their long-term health.
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Wagner N, Kagan KO, Haen S, Schmidt S, Yerlikaya G, Maden Z, Jahn G, Hamprecht K. Effective management and intrauterine treatment of congenital cytomegalovirus infection: review article and case series. J Matern Fetal Neonatal Med 2013; 27:209-14. [DOI: 10.3109/14767058.2013.806899] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Toxoplasma gondii, rubella, cytomegalovirus and herpes simplex virus have in common that they can cause congenital (TORCH) infection, leading to fetal and neonatal morbidity and mortality. During the last decades, TORCH screening, which is generally considered to be single serum testing, has been increasingly used inappropriately and questions have been raised concerning the indications and cost-effectiveness of TORCH testing. The problems of TORCH screening lie in requesting the screening for the wrong indications, wrong interpretation of the single serum results and in case there is a good indication for diagnosis of congenital infection, sending in the wrong materials. This review provides an overview of the pathogenesis, epidemiology and clinical consequences of congenital TORCH infections and discusses the indications for, and interpretation of, TORCH screens.
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Affiliation(s)
- Eveline P de Jong
- Department of Paediatrics, Juliana Children’s Hospital, HAGA Hospital, The Hague, The Netherlands
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Goncé A, Marcos MA, Borrell A, López M, Nadal A, Figueras F, Gratacós E. Maternal IgM antibody status in confirmed fetal cytomegalovirus infection detected by sonographic signs. Prenat Diagn 2012; 32:817-21. [PMID: 22639067 DOI: 10.1002/pd.3907] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the value of maternal IgM to cytomegalovirus (CMV) as a predictive factor of fetal infection in fetuses with sonographic markers. METHODS Observational study (2006-2011) including a consecutive series of 19 fetuses with sonographic markers of fetal infection and confirmed infection by positive CMV-DNA in amniotic fluid or fetal blood. We evaluated the status of maternal CMV IgM at the time of sonographic suspicion. RESULTS During this 6-year study period, CMV infection was diagnosed in 19 fetuses from 18 pregnancies, including 16 singletons, both twins of a monochorionic diamniotic pregnancy and one twin of a dichorionic pregnancy. Sonographic suspicion was established on the basis of one or more of the following: brain abnormalities (14), fetal hydrops (4), hyperechogenic bowel (4), pericardial effusion (1), cardiomegaly (1), oligoanhydramnios (4), and placentomegaly (2). Maternal IgG antibodies were positive in all cases but maternal IgM antibodies were negative in 56% of pregnancies. Five of the 10 pregnancies with negative maternal IgM were diagnosed in the second trimester and five in the third trimester. CONCLUSION In around half of fetuses with confirmed CMV infection ascertained by sonographic markers, maternal IgM antibodies are negative and should therefore not be used as a diagnostic parameter.
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Affiliation(s)
- Anna Goncé
- Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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Nigro G, Adler SP, Gatta E, Mascaretti G, Megaloikonomou A, Torre RL, Necozione S. Fetal hyperechogenic bowel may indicate congenital cytomegalovirus disease responsive to immunoglobulin therapy. J Matern Fetal Neonatal Med 2012; 25:2202-5. [DOI: 10.3109/14767058.2012.684111] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Saha E, Mullins EWS, Paramasivam G, Kumar S, Lakasing L. Perinatal outcomes of fetal echogenic bowel. Prenat Diagn 2012; 32:758-64. [PMID: 22589170 DOI: 10.1002/pd.3898] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate perinatal outcomes of fetal echogenic bowel (FEB). METHOD This is a retrospective observational study of FEB cases from Jan 2005-Dec 2010. Data from ultrasound and fetal medicine investigations, uterine artery Doppler (UAD), intra-partum care and neonatal outcome were obtained from Fetal Medicine, Obstetric and Neonatal Databases. RESULTS There were 139 cases presenting at 21(+5) (15(+1) -35(+5) ) weeks gestation. Overall, 106/139 (76.2%) were live born (LB), 8/139 (5.8%) were complicated by intra-uterine deaths (IUD), 11/139 (7.9%) had termination of pregnancy (TOP) and 14/139 (10.1%) were lost to follow-up after 28 weeks gestation. Six had chromosomal/genetic abnormalities, two had congenital cytomegalovirus, none had cystic fibrosis.Uterine artery Doppler was normal in 106/130 (81.5%) cases. In this group, there were no cases of fetal growth restriction (FGR), 95/106 (89.6%) were LB, 1/106 (0.94%) had an IUD. In the abnormal UAD group, 17/24 (70.1%) developed FGR, 11/24 (45.8%) were LB, 4/24 (16.7%) had TOP, 7/24 (29.2%) had IUD.In total, 20/106 (18.9%) live births were admitted for specialist neonatal care, 12/20 (60%) for prematurity. Only one had primary bowel pathology. CONCLUSION Pregnancies with FEB and screen positive UAD are at risk of adverse perinatal outcome. Primary bowel pathology is rare following the finding of FEB.
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Affiliation(s)
- Esha Saha
- Department of Fetal Medicine, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Ameratunga DM, Said JM, Reidy K, Palma-Dias R. Perinatal outcomes following the ultrasound diagnosis of echogenic bowel: an Australian perspective. Fetal Diagn Ther 2012; 31:179-84. [PMID: 22378220 DOI: 10.1159/000336123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 12/23/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to describe the association between fetal echogenic bowel (FEB) diagnosed during the second trimester and adverse perinatal outcomes in an Australian antenatal population. METHODS A retrospective analysis of ultrasound scans was performed between March 1, 2004 and March 1, 2009 at The Royal Women's Hospital, Melbourne, Vic., Australia. Cases reported as having FEB on second trimester ultrasound were included. Medical records of each case were reviewed and information concerning additional investigations and perinatal outcomes were extracted. RESULTS A total of 66 cases were identified in our database. Three patients (5%) were excluded from further analysis as they were lost to follow-up, leaving 63 (95%) cases in this series. Thirty-two fetuses (52%) underwent karyotyping via amniocentesis, 5 (16%) of which were found to have chromosomal defects. Maternal serology for cytomegalovirus (CMV) was performed in 49 (78%) cases. Investigations indicated a total of 5 women who had CMV infection during their pregnancy. Thirty-three pregnancies (53%) were tested for cystic fibrosis (CF) and 1 baby was confirmed to have CF postnatally. Among the 50 liveborn infants, 3 cases of fetal growth restriction were apparent. Overall, 42 of the 50 liveborn infants (84%) and 67% of the entire cohort of 63 patients with a midtrimester diagnosis of FEB had a normal short-term neonatal outcome. CONCLUSION This study reiterates the increased prevalence of aneuploidy, CMV, CF and fetal growth restriction in pregnancies complicated by the midtrimester sonographic finding of FEB. However, reassuringly, 67% of cases with ultrasound-detected echogenic bowel in the second trimester had a normal short-term neonatal outcome in this multiethnic Australian population.
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Affiliation(s)
- D M Ameratunga
- Fetal Medicine Unit and Pregnancy Research Centre, Department of Perinatal Medicine, Royal Women's Hospital, Parkville, Vic., Australia
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Abele H, Starz S, Hoopmann M, Yazdi B, Rall K, Kagan KO. Idiopathic Polyhydramnios and Postnatal Abnormalities. Fetal Diagn Ther 2012; 32:251-5. [PMID: 22760013 DOI: 10.1159/000338659] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 04/05/2012] [Indexed: 01/06/2023]
Affiliation(s)
- Harald Abele
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
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Fayyaz H, Rafi J. TORCH screening in polyhydramnios: an observational study. J Matern Fetal Neonatal Med 2011; 25:1069-72. [PMID: 21923307 DOI: 10.3109/14767058.2011.622002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The aim of this study was to understand the TORCH test and to evaluate its significance in women with polyhydramnios in singleton pregnancies. METHOD Retrospective analysis of indications and results of TORCH referrals made from November 2007 to 2009 with detailed review of case notes of women with polyhydramnios who had TORCH test. RESULTS The total number of deliveries during specimen time was 3004, out of which 110(3.6%) had serum TORCH screening. The main indication for this test was polyhydramnios 62 (56.36%) followed by obstetric cholestasis 20 (18.18%), Intra-uterine fetal demise 6 (5.45%), fetal anomalies 5(4.54%), and deranged liver function tests (LFTs) 2 (1.8%). 15 (13.6%) women had TORCH screening for other indications such as clinical polyhydramnios, increased nuchal translucency (>2.5 mm). cytomegalovirus (CMV) and toxoplasmosis antibodies were tested in all cases whereas, parvovirus and herpes simplex virus screen were carried out in 4 (12.7%) and 2 (1.8%) patients, respectively. One woman (0.09%) had infection with CMV who had TORCH screening carried out for deranged LFTs. None of these women had positive TORCH screening giving the p value of <0.0001. These women also did not have any associated perinatal or maternal mortality. CONCLUSIONS While the sample size of this study is small to disregard the significance of TORCH test in polyhydramnios, the statistical evaluation shows that this test is not beneficial in women in whom polyhydramnios is an isolated ultrasound finding, especially when it is diagnosed in third trimester.
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Affiliation(s)
- Humera Fayyaz
- Obstetrics & Gynaecology Department, Scarborough General Hospital, Woodlands Drive Scarborough, North Yorkshire, YO12 6QL, United Kingdom
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van der Weiden S, de Jong EP, Te Pas AB, Middeldorp JM, Vossen ACTM, Rijken M, Walther FJ, Lopriore E. Is routine TORCH screening and urine CMV culture warranted in small for gestational age neonates? Early Hum Dev 2011; 87:103-7. [PMID: 21145674 DOI: 10.1016/j.earlhumdev.2010.11.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/05/2010] [Accepted: 11/09/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND congenital infections are associated with a wide variety of clinical symptoms, including small for gestational age (SGA). AIMS to determine the co-occurrence of SGA and congenital TORCH infections, as diagnosed by TORCH serologic tests and/or cytomegalovirus (CMV) urine culture. STUDY DESIGN we performed a retrospective study of all neonates admitted to our neonatal intensive care unit from January 2004 to February 2010 in whom SGA was diagnosed and TORCH serologic tests and/or CMV urine cultures were performed. RESULTS TORCH serologic tests (in neonatal or maternal serum) and/or a CMV urine culture were performed in 112 neonates with SGA. None of the neonates tested positive for Toxoplasma gondii, Rubella, and Herpes simplex virus. Positive CMV urine culture was detected in 2% (2/112) of neonates, but their CMV IgM titers were negative. CONCLUSIONS the co-occurrence of TORCH congenital infection in infants with SGA is rare. Routine TORCH screening in neonates with isolated SGA does not seem warranted and should be limited to CMV urine cultures.
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Affiliation(s)
- S van der Weiden
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, The Netherlands
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Multiplex detection of IgM and IgG class antibodies to Toxoplasma gondii, rubella virus, and cytomegalovirus using a novel multiplex flow immunoassay. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2010; 17:1734-8. [PMID: 20861325 DOI: 10.1128/cvi.00332-10] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The goal of this study was to evaluate the BioPlex 2200 Toxoplasma, rubella, and cytomegalovirus (CMV) (ToRC) IgG and IgM multiplex immunoassays (Bio-Rad Laboratories, Hercules, CA) and compare the results to those of conventional testing by enzyme immunoassay (EIA) and enzyme-linked fluorescent assay (ELFA). Serum specimens (n = 600) submitted for routine ToRC IgG and IgM testing by EIA (SeraQuest, Doral, FL; Diamedix, Miami, FL) or ELFA (Vidas; bioMérieux, Durham, NC) were also tested by the BioPlex ToRC multiplex immunoassays. Samples showing discordant results were retested by both methods, with further discrepancies being arbitrated by a third assay. Following repeat testing, the BioPlex Toxoplasma, rubella, and CMV IgG assays demonstrated agreements of 98.7 (592/600 specimens), 93.3 (560/600 specimens), and 98.3% (590/600 specimens), respectively, while the ToRC IgM assays yielded agreements of 91.2 (547/600 specimens), 87.3 (524/600 specimens), and 95.2% (571/600 specimens), respectively. The BioPlex ToRC IgG assays provided results comparable to EIA/ELFA results, with kappa coefficients showing near-perfect agreement for the Toxoplasma (κ = 0.94) and CMV (κ = 0.97) IgG assays and substantial agreement for the rubella IgG assay (κ = 0.66). The BioPlex ToRC IgM assays showed lower specificity with only slight agreement for Toxoplasma IgM (κ = 0.07), poor agreement for rubella IgM (κ = -0.03), and moderate agreement for CMV IgM (κ = 0.55). Both the BioPlex IgG and IgM assays reduced turnaround time (1.7 h versus 5.5 h by EIA/ELFA for 100 specimens) and eliminated the necessity to manually pipette or aliquot specimens prior to testing.
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Routine TORCH screening is not warranted in neonates with subependymal cysts. Early Hum Dev 2010; 86:203-7. [PMID: 20227842 DOI: 10.1016/j.earlhumdev.2010.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 02/09/2010] [Accepted: 02/20/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Congenital infections are associated with a wide variety of clinical symptoms, including subependymal cysts (SEC). OBJECTIVE To determine the co-occurrence of SEC and congenital infections, as diagnosed by TORCH serologic tests and/or cytomegalovirus (CMV) urine culture. METHODS We performed a retrospective study of all neonates admitted to our neonatal intensive care unit from 1998 to 2009 in whom SEC were detected on cranial ultrasound and TORCH serologic tests and/or CMV urine cultures were performed. RESULTS Fifty-nine neonates fulfilled the inclusion criteria. TORCH serologic tests were performed in 69% (41/59) of cases. Urine CMV culture was performed in 68% (40/59) of cases. None of the neonates tested positive for IgM Toxoplasma gondii, Rubella and Herpes simplex virus. Positive CMV IgM titers and/or a positive urine CMV culture were detected in 2% (1/59) of neonates. CONCLUSION The co-occurrence of TORCH congenital infections in infants with SEC is rare. Routine TORCH screening in neonates with SEC does not seem warranted.
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Iruretagoyena JI, Bankowsky H, Heiser T, Birkeland L, Grady M, Shah D. Outcomes for fetal echogenic bowel during the second trimester ultrasound. J Matern Fetal Neonatal Med 2010; 23:1271-3. [DOI: 10.3109/14767050903551442] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Melchiorre K, Bhide A, Gika AD, Pilu G, Papageorghiou AT. Counseling in isolated mild fetal ventriculomegaly. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:212-224. [PMID: 19644944 DOI: 10.1002/uog.7307] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this Review we aim to provide up-to-date and evidence-based answers to the common questions regarding the diagnosis of isolated mild fetal ventriculomegaly (VM). A literature search was performed to identify all reports of antenatal VM in the English language literature. In addition, reference lists of articles identified using the search were scrutinized to further identify relevant articles. Fetal mild VM is commonly defined as a ventricular atrial width of 10.0-15.0 mm, and it is considered isolated if there are no associated ultrasound abnormalities. There is no good evidence to suggest that the width of the ventricular atria contributes to the risk of neurodevelopmental outcome in fetuses with mild VM. The most important prognostic factors are the association with other abnormalities that escape early detection and the progression of ventricular dilatation, which are reported to occur in about 13% and 16% of cases, respectively. Most infants with a prenatal diagnosis of isolated mild VM have normal neurological development at least in infancy. The rate of abnormal or delayed neurodevelopment in infancy is about 11%, and it is unclear whether this is higher than in the general population. Furthermore, the number of infants that develop a real handicap is unknown. There are limitations of existing studies of mild VM. Although they address many of the relevant questions regarding the prognosis and management of fetal isolated mild VM, there is a lack of good-quality postnatal follow-up studies. The resulting uncertainties make antenatal counseling for this abnormality difficult.
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Affiliation(s)
- K Melchiorre
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK
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Baquero-Artigao F. [Congenital cytomegalovirus infection: is serological screening during pregnancy necessary?]. Enferm Infecc Microbiol Clin 2009; 28:363-9. [PMID: 19409663 DOI: 10.1016/j.eimc.2009.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 01/02/2009] [Accepted: 01/08/2009] [Indexed: 10/20/2022]
Abstract
Primary cytomegalovirus (CMV) infection occurs during pregnancy in 1% to 4% of seronegative women and may be transmitted to the fetus in up to 40% of cases. Up to 10% of intrauterine CMV infections result in symptomatic congenital disease at birth. Half of these children and 13% of those born with asymptomatic infection will develop significant clinical sequelae in infancy, especially sensorineural hearing loss. Routine CMV screening during pregnancy is not recommended in Spain owing to the absence of an effective CMV vaccine, the lack of preventive measures or therapy during pregnancy, the difficulty in diagnosing a reactivated infection, and the possibility of symptomatic congenital infections in children of immune women. However, sensitive and specific methods to diagnose primary maternal and fetal infection now exist, and new preventive and therapeutic measures have been developed. Currently, these procedures are not universally available and need to be tested in larger trials. Furthermore, the prevalence of seropositive status in pregnant women, the frequency of congenital infection, and the percentage of infants born with hearing impairment and mental retardation in our country are not known. Therefore, it would not be appropriate to introduce routine screening for CMV in pregnancy at the present time. However, increased efforts should be made to inform women about congenital CMV disease, to develop the diagnosis of fetal infection and methods to determine the extent of involvement in the case of suggestive ultrasound findings, and to treat symptomatic infected newborns with antivirals to reduce hearing impairment.
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Nigro G, La Torre R, Pentimalli H, Taverna P, Lituania M, de Tejada BM, Adler SP. Regression of fetal cerebral abnormalities by primary cytomegalovirus infection following hyperimmunoglobulin therapy. Prenat Diagn 2008; 28:512-7. [PMID: 18509871 DOI: 10.1002/pd.2013] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the effects of maternal and intra-amniotic hyperimmunoglobulin (HIG) infusions among cytomegalovirus (CMV) infected fetuses with ultrasound abnormalities following a primary CMV infection. PATIENTS AND METHODS The subjects were fetuses with CMV-associated cerebral and other ultrasound abnormalities. Three mothers were treated with HIG infusions during pregnancy and two were untreated. Fetal ventricle size, organ echodensity and placental thickness were measured by ultrasound before and after HIG infusions. The children were evaluated between 3 and 7 years of age. RESULTS The ventriculomegaly of all three fetuses of HIG-treated mothers regressed and the ascites, hepatic echodensities, periventricular echodensities, and intestinal echodensities disappeared. Their sensorial, mental and motor development was normal at 4, 4.7, and 7 years of age. In contrast, both infants born of untreated mothers had signs and symptoms of severe CMV cerebropathy. CONCLUSION The outcomes of the infants born to HIG-treated mothers support the efficacy of HIG as a treatment for CMV-infected fetuses with ultrasound cerebral abnormalities.
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Affiliation(s)
- Giovanni Nigro
- Pediatric Department, University of L'Aquila, L'Aquila, Italy.
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Hyett J. Intra-abdominal masses: prenatal differential diagnosis and management. Prenat Diagn 2008; 28:645-55. [DOI: 10.1002/pd.2028] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zafar U, Ong S, Gray J, Martin WM, Kilby MD. The limitations of cytomegalovirus screening. Prenat Diagn 2006; 26:869-70. [PMID: 16941503 DOI: 10.1002/pd.1514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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