Prenatal diagnosis of fetal cytomegalovirus infection after primary or recurrent maternal infection

Objective: To determine the reliability of prenatal diagnosis of cytomegalo virus infection in women with primary or recurrent infection. Methods: Amniotic fluid (AF) samples from 117 pregnant women were evaluated for cytomegalovirus culture and cytomegalovirus-DNA detection. Neonatal an d postnatal samples also were examined to confirm or exclude transmission o f maternal-fetal cytomegalovirus infection. Results: Of 25 women with primary cytomegalovirus infection, 13 (52%) had c ytomegalovirus-positive AF samples by polymerase chain reaction (PCR), nine of which also were diagnosed by culture. All eight neonates born to mother s whose AF was cytomegalovirus-positive by PCR and culture were cytomegalov irus-infected, and three were symptomatic. One aborted fetus had cytomegalo virus-DNAemia. Of four women with cytomegalovirus-positive AF samples by PC R only two delivered asymptomatic cytomegalovirus-infected neonates and two aborted (one fetus had cytomegalovirus encephalopathy). Of 45 mothers with recurrent infection, two with AF cytomegalovirus-positiv e by PCR and culture, and another with cytomegalovirus-positive AF samples by PCR only, aborted cytomegalovirus-DNA-positive fetuses. Of the other sev en women with cytomegalovirus-positive AF samples by PCR only, two delivere d asymptomatic cytomegalovirus-infected neonates, two delivered neonates cy tomegalovirus-positive by PCR only (one was symptomatic), and three deliver ed infants cytomegalovirus-negative by PCR and culture. All 47 mothers with nonactive cytomegalovirus infection and cytomegalovirus-negative AF sample s had uninfected neonates. Polymerase chain reaction was superior to viral culture in sensitivity and negative predictive value (100% compared with 57% and 94%, respectively) bu t was lower in specificity and positive predictive value (97% and 83%, resp ectively, compared with 100%). Conclusion: Prenatal diagnosis of fetal cytomegalovirus infection should in clude PCR in addition to viral culture, particularly for congenital cytomeg alovirus infections following maternal recurrence. (Obstet Gynecol 1999;94: 909-14. (C) 1999 by The American College of Obstetricians and Gynecologists .).