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Accuracy of prenatal ultrasound screening to identify fetuses infected by cytomegalovirus who will develop severe long-term sequelae

Abstract : OBJECTIVES To compare the ability to identify infected fetuses who will develop long-term sequelae of routine ultrasound detailed examination performed without the knowledge of maternal serology and the fetal status to that of targeted prenatal imaging performed in prenatal diagnosis units in known cases of fetal infection. METHODS All prenatal imaging reports were collected for 256 children with congenital CMV in a registered cohort between 2013 and 2017 (NCT01923636). All pregnancies underwent detailed fetal ultrasound examination at 20-24 and 30-34 weeks' as part of routine antenatal care. All cases of known fetal CMV infection underwent targeted prenatal ultrasound. Postnatal structured follow-up up until 48 months included audiology and neurological assessment including Brunet-Lezine scoring. All imaging reports were analyzed retrospectively with the knowledge of congenital CMV infection searching for features that were or could have been related to fetal infection. RESULTS 237 children with complete data were followed-up to a median 24 months of whom 30% (71/237) and 70% (166/237) were diagnosed prenatally or within 3 weeks of life respectively. 73% (29/40) of children with any sequelae and 74% (14/19) with severe sequelae (bilateral hearing loss and/or neurologic sequelae) were not identified in the prenatal period. In those diagnosed prenatally sensitivity of prenatal imaging for any and severe sequelae was 91 and 100%. In the group diagnosed postnatally non-specific infection-related features were reported in 48% and 64% with any and severe sequelae without raising suspicion. CONCLUSIONS Routine ultrasound screening in pregnancy is not an appropriate screening tool for congenital CMV infection leading to long-term sequelae contrasting with the high performance of targeted prenatal imaging in known cases of fetal infections. Non-specific nature of ultrasound features and their evolution and lack of awareness of caregivers about cCMV are the main explanations. Sonologists' awareness and knowledge of maternal serological status in the first trimester seem key to the performance of routine prenatal ultrasound.
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Submitted on : Thursday, May 28, 2020 - 3:01:49 PM
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M Leruez-Ville, S Ren, Jf Magny, F Jacquemard, S Couderc, et al.. Accuracy of prenatal ultrasound screening to identify fetuses infected by cytomegalovirus who will develop severe long-term sequelae. Ultrasound in Obstetrics and Gynecology = Ultrasound in Obstetrics & Gynecology, Wiley-Blackwell, 2020, ⟨10.1002/uog.22056⟩. ⟨hal-02639291⟩

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