Diagnosis of Infections in Fetus: Ultrasound and Invasive Techniques
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REVIEW ARTICLE
Diagnosis of Infections in Fetus: Ultrasound and Invasive Techniques Anubhuti Rana1
•
K. Aparna Sharma1
Received: 15 August 2019 / Accepted: 7 July 2020 Society of Fetal Medicine 2020
Abstract Infections in pregnancy may lead to fetal morbidity and mortality. The major infections which can be transmitted from the mother to the fetus and can probably result in adverse consequences in the prenatal period include toxoplasmosis, rubella, cytomegalovirus (CMV), syphilis, parvovirus, and varicella. Factors determining the risks of transplacental transmission and associated fetal adverse events include the period of gestation at which transmission occurs and the immunity status of the mother. No single modality can diagnose all fetal infections and consequently prenatal diagnosis of fetal manifestations of infections is frequently made by fetal sonography and serology to identify the specific infectious agent. Ultrasound is now considered the safest and least invasive primary tool for the detection and monitoring of antenatal infection. Major findings in cases of fetal infection are observed in the central nervous system and heart with parenchymal calcifications, pleural/pericardial effusions, ascites, fetal growth restriction, oligo-/polyhydramnios and placentomegaly being frequently seen. Various diagnostic interventions are also performed under ultrasound guidance such as amniocentesis to determine underlying etiology and cordocentesis to detect fetal anemia. Knowledge of the various diagnostic modalities is required for appropriate counseling of the couple and for optimal treatment.
& K. Aparna Sharma [email protected] 1
Division of Fetal Medicine, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi 110029, India
Keywords Fetal infections Prenatal diagnostic procedures Amniocentesis Ultrasound Chorionic villus sampling Cordocentesis
Introduction Infections in pregnancy are a common cause of fetal morbidity and mortality. Maternal infections can be transmitted to the fetus; however, neither are all fetuses infected nor symptomatic. The various infections which can cause congenital defects include TORCH infections, parvovirus B19, varicella zoster and most recently Zika virus. With the increasing awareness of the impact of fetal infections, the need for updating the diagnostic techniques for in utero infections has also been realized. Prenatal manifestation of fetal infections can be seen on ultrasound. Diagnosis would require demonstrating maternal seroconversion and/or invasive fetal testing.
Role of Ultrasound in Diagnosis of Infections in Fetus The detection of microorganisms by cultures, immunologic methods, and special molecular biology techniques has traditionally been the mainstay for diagnosis of fetal infections [1]. However, it is seen that apart from cases of fetal infections with subtle abnormalities, obvious fetal malformation and/or fetal death can occur by the time infection is confirmed by these techniques. Ultrasound can
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