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Background <p>To assess the association between prenatal ultrasonography and intrauterine Cytomegalovirus (CMV) infection and to elucidate its clinical characteristics.</p> Methods <p>Cases were selected from three medical centers (2015–2024) in which amniotic fluid CMV-DNA testing was performed following prenatal ultrasound findings suggestive of CMV infection. CMV infection rates were analyzed in relation to distinct sonographic abnormalities. Associations between amniotic fluid viral load, imaging characteristics, and pregnancy outcomes were subsequently evaluated.</p> Results <p>Among 1,174 pregnant women, 45 (3.83%) tested positive for CMV‑DNA in amniotic fluid. Sonographic findings with CMV infection rates exceeding 50% included fetal intracranial hyperechogenicity, intraventricular adhesions, hepatosplenomegaly, and placental thickening. The infection rate was significantly higher in fetuses with multiple abnormalities (10.42%) than with isolated findings (2.14%) (<i>P</i>&lt;0.001). Combined intracranial and extracranial abnormalities carried a higher infection rate (13.41%) than purely intracranial (3.28%) or purely extracranial (2.76%) abnormalities (<i>P</i>&lt;0.001). In CMV‑positive cases, amniotic fluid VL ranged from 1.1 × 10² to 7.71 × 10⁷ copies/mL (median 3.86 × 10⁵ copies/mL). VL was significantly elevated in cases with intracranial, severe, or non‑isolated abnormalities (<i>P</i>&lt;0.05). Of 14 cases tested for cord blood CMV‑IgM, 10 (71.43%) were positive; intracranial abnormalities were present in 8 of these, but in none of the IgM‑negative cases. Maternal CMV‑IgM was positive in only 2/19 (10.53%) infected cases. Pregnancy was terminated in 25 cases; among 13 live‑born infants with follow‑up, 9 had normal outcomes, 3 had hearing impairment, and 1 had severe neurological sequelae.</p> Conclusions <p>Specific prenatal ultrasound findings show a high rate of association with intrauterine CMV infection, especially when there are multiple abnormalities or when abnormalities involve both the intracranial and extracranial compartments. Amniotic fluid CMV-DNA load correlates positively with the presence of intracranial abnormalities and overall severity of ultrasound findings.</p>

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Prenatal ultrasound findings associated with intrauterine CMV infection: a multicenter retrospective analysis of clinical and sonographic features

  • 期刊论文

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  • 发表日期：

    2026年7月29日

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  • Shilin Zhong,
  • Yan Feng,
  • Ruona Zheng,
  • Taige Wu,
  • Ting Lei,
  • Lin Chen,
  • Huanjun Wang,
  • Mengzhi Hong,
  • Xiaomei Zhang,
  • Hongning Xie,
  • Hao Huang,
  • Xuan Huang

摘要

Background

To assess the association between prenatal ultrasonography and intrauterine Cytomegalovirus (CMV) infection and to elucidate its clinical characteristics.

Methods

Cases were selected from three medical centers (2015–2024) in which amniotic fluid CMV-DNA testing was performed following prenatal ultrasound findings suggestive of CMV infection. CMV infection rates were analyzed in relation to distinct sonographic abnormalities. Associations between amniotic fluid viral load, imaging characteristics, and pregnancy outcomes were subsequently evaluated.

Results

Among 1,174 pregnant women, 45 (3.83%) tested positive for CMV‑DNA in amniotic fluid. Sonographic findings with CMV infection rates exceeding 50% included fetal intracranial hyperechogenicity, intraventricular adhesions, hepatosplenomegaly, and placental thickening. The infection rate was significantly higher in fetuses with multiple abnormalities (10.42%) than with isolated findings (2.14%) (P<0.001). Combined intracranial and extracranial abnormalities carried a higher infection rate (13.41%) than purely intracranial (3.28%) or purely extracranial (2.76%) abnormalities (P<0.001). In CMV‑positive cases, amniotic fluid VL ranged from 1.1 × 10² to 7.71 × 10⁷ copies/mL (median 3.86 × 10⁵ copies/mL). VL was significantly elevated in cases with intracranial, severe, or non‑isolated abnormalities (P<0.05). Of 14 cases tested for cord blood CMV‑IgM, 10 (71.43%) were positive; intracranial abnormalities were present in 8 of these, but in none of the IgM‑negative cases. Maternal CMV‑IgM was positive in only 2/19 (10.53%) infected cases. Pregnancy was terminated in 25 cases; among 13 live‑born infants with follow‑up, 9 had normal outcomes, 3 had hearing impairment, and 1 had severe neurological sequelae.

Conclusions

Specific prenatal ultrasound findings show a high rate of association with intrauterine CMV infection, especially when there are multiple abnormalities or when abnormalities involve both the intracranial and extracranial compartments. Amniotic fluid CMV-DNA load correlates positively with the presence of intracranial abnormalities and overall severity of ultrasound findings.