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Objective: To evaluate the feasibility of amplification of the viral genome by polymerase chain reaction (PCR) analysis of trophoblast samples obtained by chorionic villus sampling (CVS) in cases of maternal primary infection (MPI) with cytomegalovirus (CMV) in early pregnancy.Methods: This was a prospective study carried out at the Department of Obstetrics and Fetal Medicine, Hopital Necker-E.M., between October 2019 and October 2020. Following CMV serology screening in early pregnancy, CVS was offered to women at 11-14 weeks' gestation after CMV-MPI ≤ 10 weeks. Array-comparative genomic hybridization and amplification of the viral genome by PCR were performed on the trophoblasts obtained by CVS. All cases also underwent amniocentesis from 17 weeks onwards and PCR was performed on the amniotic fluid. Secondary prevention with valacyclovir was initiated as soon as MPI was diagnosed, to decrease the risk of vertical transmission. We evaluated the diagnostic performance of CMV-PCR of trophoblast obtained by CVS, using as the reference standard PCR of amniotic fluid obtained by amniocentesis.Results: CVS was performed in 37 pregnancies, at a median (range) gestational age of 12.7 (11.3-14.4) weeks. CMV-PCR in chorionic villi was positive in three and negative in 34 cases. CMV-PCR following amniocentesis, performed at a median (range) gestational age of 17.6 (16.7-29.9) weeks, was positive for the three cases which were positive following CVS and, of the 34 patients with a negative finding following CVS, amniocentesis was negative in 31 and positive in three. The sensitivity of CMV-PCR analysis of trophoblast obtained by CVS for the diagnosis of CMV, using as the reference standard PCR analysis of amniotic fluid obtained by amniocentesis, was 50% (95% CI, 19-81%), specificity was 100% (95% CI, 89-100%), positive predictive value was 100% (95% CI, 44-100%) and negative predictive value was 91% (95% CI, 77-97%).Conclusions: Diagnosis of placental infection following MPI in early pregnancy can be achieved by PCR amplification of the CMV genome in chorionic villi. We propose that negative CMV-PCR in the trophoblast after 12 weeks could be used to exclude CMV-related embryopathy leading to sequelae. However, this needs to be confirmed through long-term follow-up evaluation. These findings could help to establish CVS as the diagnostic test of choice following maternal serology screening in early pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article discusses a study that aimed to identify non-invasive markers for predicting fetal infection with cytomegalovirus (CMV) following maternal primary infection (MPI) before 14 weeks of gestation. The researchers conducted a retrospective study and found that the maximum trophoblast thickness (MTT) measured using three-dimensional ultrasound was significantly larger in cases where CMV was detected in the trophoblast and amniotic fluid. The study suggests that MTT could be a relevant and reproducible marker for diagnosing fetal CMV infection, but further research is needed to determine the threshold for MTT. The article was written by N. Bourgon, M. Jacquier, J. Fourgeaud, T. Guillerminot, L. Bussières, M. Leruez-Ville, and Y. Ville. [Extracted from the article]

This article, titled "EP04.01: First trimester diagnosis of cytomegalovirus trophoblastic infection using CMV-PCR: prediction of fetal CMV infection and symptoms at birth," discusses the use of CMV-PCR in diagnosing trophoblastic infection in pregnant women. The study aimed to determine the value of CMV-PCR in predicting fetal CMV infection and symptoms at birth. The results showed that CMV-PCR in trophoblast had a high negative predictive value for fetal infection and a high specificity and negative predictive value for symptomatic infection at birth. The study suggests that CMV-PCR on trophoblast can be a useful tool in diagnosing and predicting CMV infection in fetuses. [Extracted from the article]

This article discusses the challenges of predicting the postnatal outcomes of congenital cytomegalovirus (CMV) infection during pregnancy. The study evaluated the effectiveness of prenatal assessment, including different machine learning techniques, in predicting symptoms at birth and long-term sequelae. The research involved a large cohort of pregnant women who were referred for fetal infection following maternal infection in early pregnancy. The results suggest that prenatal imaging and early prenatal treatment, particularly in cases with mild prenatal findings, can influence the prognosis of infected fetuses. [Extracted from the article]

Objective: To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection <14 weeks of gestation, at different time points of pregnancy: the end of the second trimester; following prenatal magnetic resonance imaging (MRI) at 32 weeks of gestation; and using all ultrasound scans performed in the third trimester (US3rdT).Design: A retrospective study.Setting: Reference fetal medicine unit.Population: Sixty-two fetuses infected <14 weeks of gestation.Methods: We defined second-trimester assessment (STA) as the combination of ultrasound findings <28 weeks of gestation and fetal platelet count at cordocentesis. Three groups were defined: normal, extracerebral, and cerebral STA.Main Outcome Measures: For each group, the PV of STA alone, STA + MRI, and STA + US3rdT were assessed retrospectively. Outcome at birth and at follow-up were reported.Results: The STA was normal, and with extracerebral and cerebral features, in 43.5, 42.0, and 14.5%, respectively. The negative PV of normal STA and MRI for moderate to severe sequelae was 100%. The residual risk was unilateral hearing loss in 16.7% of cases. Of pregnancies with cerebral STA, 44% were terminated. Following extracerebral STA, 48% of neonates were symptomatic and 30% had moderate to severe sequelae. In those cases, the positive and negative PV of MRI for sequelae were 33 and 73%, respectively. STA + US3rdT had a lower negative PV than MRI for symptoms at birth and for moderate to severe sequelae. Any false-positive findings at MRI were mostly the result of hypersignals of white matter.Conclusions: Serial assessment in the second and third trimesters by ultrasound and MRI is necessary to predict the risk of sequelae occurring in 35% of pregnancies following fetal infection in the first trimester of pregnancy.Tweetable Abstract: Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks. [ABSTRACT FROM AUTHOR]

Objective: To assess the cost‐effectiveness of prenatal detection of congenital cytomegalovirus (cCMV) following maternal primary infection in the first trimester within standard pregnancy follow‐up or involving population‐based screening (serological testing at 7 and 12 weeks of gestation), with or without secondary prevention (valaciclovir) in maternal CMV primary infection. Design: Cost‐effectiveness study from the perspective of the French national health insurance system. Setting: Cost‐effectiveness based on previously published probability estimates and associated plausible ranges hypothetical population of 1,000,000 pregnant women. Population: Hypothetical population of 1,000,000 pregnant women. Methods: Cost‐effectiveness of detecting fetal cCMV in terms of the total direct medical costs involved and associated expected outcomes. Main outcome measures: Detection rates and clinical outcomes at birth. Results: Moving to a population‐based approach for targeting fetal CMV infections would generate high monetary and organizational costs while increasing detection rates from 15% to 94%. This resource allocation would help implementing horizontal equity according to which individuals with similar medical needs should be treated equally. Secondary prevention with valaciclovir had a significant effect on maternal‐fetal CMV transmission and clinical outcomes in newborns, with a 58% decrease of severely infected newborns for a 3.5% additional total costs. Accounting for women decision‐making (amniocentesis uptake and termination of pregnancy in severe cases) did not impact the cost‐effectiveness results. Conclusions: These findings could fuel thinking on the opportunity of developing clinical guidelines to rule identification of cCMV infection and administration of in‐utero treatment. These findings could fuel the development of clinical guidelines on the identification of congenital CMV infection and the administration of treatment in utero. CMV serological screening followed by valaciclovir prevention may prevent 58% to 71% of severe cCMV cases for 38 € per pregnancy. CMV serological screening followed by valaciclovir prevention may prevent 58% to 71% of severe cCMV cases for 38 € per pregnancy. [ABSTRACT FROM AUTHOR]