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CMV infection in Pregnancy: A Consultation Dilemma

CMV infection in Pregnancy: A Consultation Dilemma. Joseph Pardo, MD Helen Schneider Hospital for Women Israel. Periconceptual infection Previous Studies. 2 previous studies: Limited sample size Non-uniform definitions of the periconceptional period

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CMV infection in Pregnancy: A Consultation Dilemma

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  1. CMV infection in Pregnancy: A Consultation Dilemma Joseph Pardo, MD Helen Schneider Hospital for Women Israel

  2. Periconceptual infection Previous Studies 2 previous studies: Limited sample size Non-uniform definitions of the periconceptional period Daiminger et al: (obstet & gyn survey 2005) Definition: [-1] week to [+5] weeks after LMP, correlates to ±3 week period from the assumed time of conception. N=20 Prevalence: 17.6% Transmission rate: 45% Revello et al: (jour. Of inf. Dis. 2002) Definition: [+4] weeks after LMP, corresponding to ± 2 weeks around conception N =20 Prevalence: 12-18% Transmission rate: 31%

  3. Methods Retrospective cohort study Consecutive Periconceptional CMV infection from 1999 until 2008 Single tertiary center. Periconceptional CMV infection: Primary infection occurring between [-4] weeks to [+3] weeks following LMP 1) Positive CMV specific IgM and IgG antibodies, along with low IgG avidity, up to 11 weeks of gestation.2) Negative CMV IgG and positive CMV IgM detected at least 4 weeks before LMP, and up to 8 weeks of pregnancy Specific Cmv-IgM appears 5 weeks following primary CMV infection and IgG is detected in patient's serum 7 weeks after infection In cases of isolated positive IgM: Infection diagnosed only if IgG appeared

  4. Confirmed Periconceptual Primary CMV Infection Amniocentesis [+] (n=43) Amniocentesis [-] (n=16) CMV [+] (n=11) CMV [-] (n=32) Late TOP (n=10) LFU (n=1) SA (n=4) Early TOP (n=2) Normal (n=8) LFU (n=2) Urine CMV [+](n=2) Urine CMV[-] (n=6) Figure 1: Results of Periconceptual CMV work up, and pregnancy outcome. CMV, Cytomegalovirus. TOP, Termination of Pregnancy. LFU, Lost to Follow Up. SA, Spontaneous Abortion

  5. Results Total of 412 consecutive pregnant women evaluated: 59 primary periconceptional CMV Infection The prevalence of periconceptional CMV infection, out of the total population of positive CMV mothers referred to our clinic, is 14.3% (59/412). Vertical infection, with periconceptional maternal CMV infection is lower than previously mentioned, and is only 25.6% The follow up time was on average 4.5 years (8.8 months to 9.7 years).

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