TORCH INFECTIONS AND PRENATAL ULTRASOUND FINDINGS
Eran Casiff M.D.
Department of Obstetrics and Gynecology Kaplan Medical Center Rehovot 76100, Israel
Limitations
• Most infected fetuses are sonographically normal • Ultrasound findings may change with time • no correlation with infant outcome
Cerebral Ventriculomegaly
• Measured at the posterior aspect of the choroid plexus • Almost always symmetric • 5% of cases can be attributed to fetal infection
Intracranial Calcifications
• Intrauterine infection • Periventricular hyperechoic foci - the hallmark • May be located in the thalami and basal ganglia • Small with no acoustic shadowing • Most frequently seen with CMV and Toxoplasmosis
hydranencephaly
• Most severe manifestation of the destructive process • Cerebral hemispheres replaced by fluid, brain stem preserved, falx present, absent or deviated, posterior fossa structures can be identified • reported in Herpes simplex, Toxoplasmosis and CMV
Microcephaly
• Often associated with other CNS anomalies • Diagnosed as three SD below the mean for gestational age • Abnormal HC/AC and HC/FL ratios • Isolated microcephaly documented in CMV, Rubella and Herpes simplex
Cardiac abnormalities
• Cardiomegaly, mostly in CMV • Cardiothoracic ratio • VSD, ASD, Pulmonic stenosis and coaractation of the aorta in Rubella
Hepatosplenomegaly
• Documented in all TORCH infection • Often a transient finding • Normograms are available
Intra-abdominal Calcifications
• Typical appearance: echgenic foci with acoustic shadowing • Peritoneum, intestinal lumen, organ parenchyma, biliary tree and vascular structures • Echogenic bowel in CMV and Toxoplasmosis
Hydrops, Placenta and Amniotic fluid
• Hydrops reported in most TORCH but may be transient • Placentomegaly is usually associated with intrauterine infection, but small placentae have also been reported • Hydramnios and oligohydramnios have been reported with similar frequency
Fetal growth restriction
• Estimated weight below the 10th percentile • common feature with CMV, Rubella, Herpes simplex and Varicella • Usually not seen with Toxoplasmosis and Syphylis
TOXOPLASMOSIS
• Ventriculomegaly is the most frequently documented finding • Intracranial calcifications, placentomegaly, liver calcifications and ascites • hyperechoic bowel have been reported • microcephaly never been reported in utero
SYPHILIS
• Hepatomegaly and Placentomegaly are the most frequent sonographic manifestations • Ascites, Hydrops and Hydramnios are less commonly reported • Resolution of sonographic signs have been reported with maternal antibiotic therapy
RUBELLA
• Incidence less than 1:100,000 live birth • Prenatal diagnosis by sonographic findings have never been reported • Potential detected abnormalities include: cardiac anomalies, microcephaly, hepatosplenomegaly, FGR, microphtalmia and cataract
CMV
• The most common congenital infection affecting 1% of all live births • 10% of infected neonates demonstrate clinical manifestations that potentially could be identified by prenatal sonography • Ventriculomegaly, FGR, Intracranial calcifications and oligohydramnios are the most frequently reported findings
HERPES SIMPLEX
• HSV are usually acquired at birth • Intrauterine infections resulting in clinical signs has been reported in 100 cases worldwide • Hydranencephaly is the only sonographic sign reported antenatally • Microcephaly, intracranial calcifications and FGR are potentially detectable
VARICELLA ZOSTER
• The most common finding is Hydramnios • Also reported: liver calcifications, hepatomegaly, hydrops, limd deformities, ventriculomegaly and FGR
SUMMARY
• Sonography is not a sensetive test for fetal infection • Normal fetal anatomy survey cannot predict a favorable outcome • Multiple organ systems are affected in 50% of cases
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