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Fa F, Laup L, Mandelbrot L, Sibiude J, Picone O. Fetal and neonatal abnormalities due to congenital herpes simplex virus infection: a literature review. Prenat Diagn 2020; 40:408-414. [PMID: 31663621 DOI: 10.1002/pd.5587] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/30/2019] [Accepted: 10/06/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Herpes simplex virus (HSV) infection during pregnancy can cause severe neonatal infections. It is also a rare cause of congenital infections. We aimed to describe fetal and neonatal abnormalities of congenital HSV infection in order to define the features that are accessible to prenatal diagnosis during ultrasound screening and/or during a work-up for congenital malformations. METHODS We analysed all cases of congenital HSV infection (CHI) described before and/or after birth and identified in Pubed and classified the findings as accessible or not to prenatal diagnosis. RESULTS Thirty-six cases of congenital herpes infection were reported, of which 15 were described prenatally and 21 postnatally. The most frequently reported malformations accessible to prenatal diagnosis were cerebral anomalies. The most common abnormalities described after birth were skin lesions and keratitis, which are not considered amenable to prenatal ultrasound detection. CHI can due to either HSV1 or HSV2 infection, whether primary or non-primary infection, with or without the presence of maternal symptoms. CONCLUSION Prenatal ultrasound abnormalities due to CHI are rare, varied and non-specific. There is no clear role for fetal ultrasound in the routine management of women with primary or non-primary HSV infection in pregnancy. However, in fetuses with ultrasound abnormalities suggestive of congenital infection, HSV should still be considered as a differential diagnosis after the more common in utero infections, such as cytomegalovirus, are excluded.
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Affiliation(s)
- Francesca Fa
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, 178 rue des Renouillers, 92701, Colombes cedex, France.,Université de Paris, Paris, France
| | - Laetitia Laup
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, 178 rue des Renouillers, 92701, Colombes cedex, France.,Université de Paris, Paris, France.,DHU Risques et Grossesse, Paris, France
| | - Laurent Mandelbrot
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, 178 rue des Renouillers, 92701, Colombes cedex, France.,Université de Paris, Paris, France.,DHU Risques et Grossesse, Paris, France.,Groupe de Recherche sur les Infections pendant la grossesse (GRIG), Vélizy, France.,Inserm IAME-U1137, Paris, France
| | - Jeanne Sibiude
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, 178 rue des Renouillers, 92701, Colombes cedex, France.,Université de Paris, Paris, France.,DHU Risques et Grossesse, Paris, France.,Groupe de Recherche sur les Infections pendant la grossesse (GRIG), Vélizy, France.,Inserm IAME-U1137, Paris, France
| | - Olivier Picone
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, 178 rue des Renouillers, 92701, Colombes cedex, France.,Université de Paris, Paris, France.,DHU Risques et Grossesse, Paris, France.,Groupe de Recherche sur les Infections pendant la grossesse (GRIG), Vélizy, France.,Inserm IAME-U1137, Paris, France
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Picone O. [Genital herpes and pregnancy: Epidemiology, clinical manifestations, prevention and screening. Guidelines for clinical practice from the French College of Gynecologists and Obstetrician (CNGOF)]. ACTA ACUST UNITED AC 2017; 45:642-654. [PMID: 29146286 DOI: 10.1016/j.gofs.2017.10.002] [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: 09/12/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To analyze the consequences of genital herpes infections in pregnant women. METHODS The PubMed database and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS The symptomatology of herpes genital rash is often atypical (NP2) and not different during pregnancy (Professional consensus). It is most often due to HSV2 (NP2). Seventy percent of pregnant patients have a history of infection with Herpes simplex virus, without reference to genital or labial localization, and this is in most cases type 1 (NP2). The prevalence of clinical herpes lesions at birth in the event of recurrence is about 16% compared with 36% in the case of initial infection (NP4). In HSV+ patients, asymptomatic herpetic excretion is 4 to 10%. The rate of excretion increases in HIV+ patients (20 to 30%) (NP2). The risk of HSV seroconversion during pregnancy is 1 to 5% (NP2), but can reach 20% in case of sero-discordant couple (NP2). Questioning is not always sufficient to determine the history of herpes infection of a patient and her partner (NP2) and the clinical examination is not always reliable (NP2). Herpetic hepatitis and encephalitis are rare and potentially severe (NP4). These diagnoses should be discussed during pregnancy and antiviral therapy should be started as soon as possible (Professional consensus). There is no established link between herpes infection and miscarriages (NP3). There appears to be an association between untreated herpes infection and premature delivery (NP3) but not in the case of treated infections (NP4). Herpetic fetopathies are exceptional (NP4). There is no argument for recommending specific prenatal diagnosis for herpes infection during pregnancy (Professional consensus). Condom use reduces the risk of initial infection in women who are not pregnant (NP3). There is no evidence to justify routine screening during pregnancy (Professional consensus). CONCLUSION There is a strong discrepancy between the prevalence of herpetic excretion at the time of delivery and the scarcity of neonatal infections. There is a lack of data on the impact of herpes infections during pregnancy in France. Fetal and maternal consequences are potentially serious but rare.
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Affiliation(s)
- O Picone
- Department of Gynaecology and Obstetrics, hôpital Louis-Mourier, hôpitaux universitaires Paris Nord, 147, rue des Renouillets, 92700 Colombes, France.
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Pruksanusak N, Rujirabanjerd S, Kanjanapradit K, Kor-anantakul O, Suntharasaj T, Suwanrath C, Hanprasertpong T, Pranpanus S. Prenatal diagnosis of complete trisomy 9 with a novel sonographic finding of heart calcification. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1871-1873. [PMID: 25253836 DOI: 10.7863/ultra.33.10.1871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Ninlapa Pruksanusak
- Department of Obstetrics and Gynecology (N.P., O.K., T.S., C.S., T.H., S.P.), Department of Pathology (S.R., K.K.), Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sinitdhorn Rujirabanjerd
- Department of Obstetrics and Gynecology (N.P., O.K., T.S., C.S., T.H., S.P.), Department of Pathology (S.R., K.K.), Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kanet Kanjanapradit
- Department of Obstetrics and Gynecology (N.P., O.K., T.S., C.S., T.H., S.P.), Department of Pathology (S.R., K.K.), Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Ounjai Kor-anantakul
- Department of Obstetrics and Gynecology (N.P., O.K., T.S., C.S., T.H., S.P.), Department of Pathology (S.R., K.K.), Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Thitima Suntharasaj
- Department of Obstetrics and Gynecology (N.P., O.K., T.S., C.S., T.H., S.P.), Department of Pathology (S.R., K.K.), Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chitkasaem Suwanrath
- Department of Obstetrics and Gynecology (N.P., O.K., T.S., C.S., T.H., S.P.), Department of Pathology (S.R., K.K.), Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Tharangrut Hanprasertpong
- Department of Obstetrics and Gynecology (N.P., O.K., T.S., C.S., T.H., S.P.), Department of Pathology (S.R., K.K.), Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Savitree Pranpanus
- Department of Obstetrics and Gynecology (N.P., O.K., T.S., C.S., T.H., S.P.), Department of Pathology (S.R., K.K.), Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Abstract
UNLABELLED Viral infections are a major cause of fetal morbidity and mortality. Transplacental transmission of the virus, even in subclinical maternal infection, may result in a severe congenital syndrome. Prenatal detection of viral infection is based on fetal sonographic findings and polymerase chain reaction to identify the specific infectious agent. Most affected fetuses appear sonographically normal, but serial scanning may reveal evolving findings. Common sonographic abnormalities, although nonspecific, may be indicative of fetal viral infections. These include growth restriction, ascites, hydrops, ventriculomegaly, intracranial calcifications, hydrocephaly, microcephaly, cardiac anomalies, hepatosplenomegaly, echogenic bowel, placentomegaly, and abnormal amniotic fluid volume. Some of the pathognomonic sonographic findings enable diagnosis of a specific congenital syndrome (eg, ventriculomegaly and intracranial and hepatic calcifications in cytomegalovirus, eye and cardiac anomalies in congenital rubella syndrome, limb contractures and cerebral anomalies in varicella zoster virus). When abnormalities are detected on ultrasound, a thorough fetal evaluation is recommended because of multiorgan involvement. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to recall that both clinical and subclinical maternal viral infections can cross the placenta, explain that there are specific sonographic findings along with laboratory findings to detect infectious agents, and state that when sonographic abnormalities are detected fetal viral infections need to be considered.
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Affiliation(s)
- Shimon Degani
- Department of Obstetrics and Gynecology, Bnei-Zion Medical Center, Ruth and Baruch Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel.
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Current awareness in prenatal diagnosis. Prenat Diagn 2005; 25:269-74. [PMID: 16007763 DOI: 10.1002/pd.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Vettraino IM, Hoprasart NJ, Bronsteen RA, Comstock CH. Clinical implications of the prenatal sonographic finding of fetal myocardial echogenic foci. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:195-199. [PMID: 15661950 DOI: 10.7863/jum.2005.24.2.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the clinical implications of fetal echogenic foci limited to the myocardium of the ventricular wall (EMF) or intraventricular septum detected during prenatal sonography. METHODS A retrospective review of fetuses found to have EMF during prenatal sonography from April 1990 through December 2003 was undertaken. Videotapes and reports were reviewed to determine the indication for sonography, gestational age, location, sonographic characteristics of the masses, and additional fetal findings. Sources of outcome data included neonatal and pediatric records and echocardiographic reports. RESULTS Five fetuses were identified. Indications for sonographic evaluation included fetal growth (n = 4) and follow-up twin-twin transfusion syndrome (n = 1). Mean gestational age +/- SD at diagnosis was 23.7 +/- 8.0 weeks (range, 17.1-36.4 weeks). The EMF identified were within the right ventricular myocardium (n = 2), intraventricular septum (n = 1), left ventricular myocardium (n = 1), and myocardium of the cardiac apex (n = 1). All foci appeared sonographically "bright as bone." The foci ranged in size from 0.1 x 0.1 to 1.2 x 0.9 cm. Neonatal echocardiographic findings were reported as normal for each of the cases. Follow-up examinations available for up to 2.5 years of age showed normal cardiac function. CONCLUSIONS The prenatal identification of EMF is unlikely to lead to notable short-term pathologic conditions because the fetuses in this investigation had unremarkable neonatal and pediatric echocardiograms and normal cardiac function.
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Affiliation(s)
- Ivana M Vettraino
- Department of Obstetrics and Gynecology, Division of Fetal Imaging, William Beaumont Hospital, 3601 W Thirteen Mile Rd, Royal Oak, MI 48073-6769, USA.
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