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Background. L’infezione primaria da Citomegalovirus (CMV) in gravidanza può portare a infezione congenita in circa il 30% dei casi, di cui 15-20% possono sviluppare sintomi a lungo termine inclusi deficit uditivi e sequele neurologiche. Gravi anomalie cerebrali nello studio ecografico prenatale sono associate a peggiore prognosi, ma è più difficile stabilire gli esiti post-natali nei feti con anomalie ecografiche non gravi. Obiettivi. Valutazione del potere predittivo di malattia sintomatica delle anomalie ecografiche non gravi, in associazione all’amniocentesi, determinabili entro la ventiduesima settimana di gestazione. Metodi. Studio prospettico osservazionale di donne con infezione primaria in gravidanza tra il 2007 e 2015: le pazienti sono state sottoposte a studio ecografico e neurosografico della morfologia fetale ed isolamento virale su liquido amniotico tra 20 e 21 settimane di gestazione, ad almeno 6 settimane dal presunto contagio materno. I segni e i sintomi di malattia congenita sono stati valutati alla nascita e al follow up nei nati vivi e attraverso l’esame autoptico nei casi di interruzione di gravidanza. Risultati. Lo studio ecografico prenatale di 306 gravidanze complicate da infezione primaria da CMV ha rilevato la presenza di anomalie cerebrali lievi e/o extracerebrali in 15 casi (4.9%). Tali reperti si sono dimostrati significativamente associati alla presenza di malattia sintomatica post-natale (OR= 18.5; 95% CI: 5.43-62.8, P, Background. Primary maternal Cytomegalovirus (CMV) infection during pregnancy can lead to congenital infection in around 30% of newborns, with 15-20% of infected children developing long-term symptoms including hearing loss and neurological sequelae. Severe brain ultrasound anomalies are associated with poor prognosis, but post-natal outcomes of fetuses with mild ultrasound anomalies are difficult to establish. Objective. The aim of the study was to evaluate the predictive value of mild ultrasound anomalies and viral load in amniotic fluid, performed before twenty-second week of gestation, in relation to the presence of symptomatic congenital disease. Methods. This is a prospective observational study of pregnant women with primary CMV infection enrolled between 2007 and 2015: fetal ultrasound scan with detailed neurosonogram and viral isolation in amniotic fluid were performed in all pregnancies between 20 and 21 weeks of gestation, at least 6 weeks after maternal infection. Sign and symptoms of congenital infection were evaluated at birth and at neonatal follow up in live-borns, post-mortem examinations were carried out in second trimester aborted fetuses. Results. Ultrasound fetal scan of 306 pregnant women with primary CMV infection detected the presence of mild cerebral and extracerebral anomalies in 15 cases (4.9%). These features was significantly associated with symptomatic congenital disease (OR= 18.5; 95%CI: 5.43-62.8, P

Genital herpes is a common sexually transmitted infection. In reproductive age it involves the additional risk of vertical transmission to the neonate. Rates of transmission are affected by the viral type and whether the infection around delivery is primary or recurrent. Neonatal herpes is a rare but very severe complication of genital herpes infection and is caused by contact with infected genital secretions at the time of labor. Maternal acquisition of herpes simplex virus (HSV) in the third trimester of pregnancy carries the highest risk of neonatal transmission. Prevention of neonatal herpes depends on preventing acquisition of genital HSV infection during late pregnancy and avoiding exposure of the infant to herpetic lesions during delivery. Uninfected woman should be counselled about the need of avoiding sexual contact during the third trimester. Elective caesarean section before the onset of labor is the choice mode of delivery for women with genital lesions or with prodromal symptoms near the term, even if it offers only a partial protection against neonatal infection. Antiviral suppressive therapy is used from 36 weeks of gestation until delivery in pregnant women with recurrences to prevent genital lesions at the time of labor so reducing the need of caesarean sections. Currently, routine maternal serologic screening is not yet recommended. Because most mothers of infants who acquire neonatal herpes lack histories of clinically evident genital herpes, researchers should focus on the recognition of asymptomatic primary genital HSV infections.

Objective: The aim was to determine the outcome of pregnancies complicated by maternal Parvovirus B19 (B19) infection. Method: Among 175 pregnant women referred to our clinic because of suspicion of a B19 infection, 63 with confirmed laboratory diagnosis of acute/recent B19 infection were followed up by ultrasound and Doppler measurement of the middle cerebral artery peak systolic velocity. Results: The vertical transmission rate was 31.7% (20/63). Of the 20 infected, 8 had hydrops, 1 had signs suggestive of meconium peritonitis and 1 had an isolated hydrothorax. Three fetuses presenting with hydrops were treated with intrauterine blood transfusion. Two of them died while the last showed resolution of anemia. Among the five untreated hydropic fetuses, one presented with mild signs that resolved spontaneously, two died at 16 and 17 weeks of gestation and two had also cardiomegaly and the parents opted for elective termination of pregnancy. All the anemic fetuses had middle cerebral artery peak systolic velocity values more than 1.8 multiples of the median. No stillbirth occurred. Conclusions: The outcome of uncomplicated cases with B19 infection is good. In the presence of hydrops prognosis was very poor. It seems therefore logical to attempt to pick up this ominous signs early. © 2012 John Wiley & Sons, Ltd.

Background In developed countries the rate of vertical transmission of HIV has dramatically declined after the introduction of a combination of measures represented by antiretroviral treatment before and at delivery, elective caesarean section and elimination of breastfeeding. Such measures are strongly effective and COULD reduced vertical transmission in many cases close to 0%. However, they can only be applied if the woman with HIV infection is aware of being infected: although HIV testing is always recommended during pre-conception counselling, many pregnancies are not preceded by a counselling visit, and a substantial proportion of pregnancies are not planned at all; so it is not uncommon to have a first assessment for HIV and other infections once pregnancy is already established. National data about pregnancies of HIV-infected women reported rate of 26.6% pregnancies characterized by a previously undetected HIV infection. The objectives of the present study were to assess the rate of women arriving at the time of delivery with unknown HIV status and to register the timing of availability laboratory results of the screening, in order to detect the possibility of a dismissed diagnosis before delivery. Material and Methods Data were collected by informatics consultation of clinical documentation of pregnant women delivering at the S. Orsola Hospital, where more than 3000 deliveries take place every year. We evaluated deliveries occurred during 4 sample-monthes in the years 2008-2009. We registered the effective annotation in the patients charts of HIV testing occurred during pregnancy, determined by a review of prenatal care records, which women submit ad admission and we evaluated the timing of availability of laboratory results (enzyme immunoassay) versus timing of delivery, were testing was performed at admission in women with no documented HIV testing records. Results: HIV status was present in 1136 (99.5%) charts of 1142 women at delivery: in 1002 cases (87.7%) HIV testing was performed during pregnancy and it was absent in the remain 134 (11.7%) women, so laboratory analysis (EIA) was performed. Laboratory results were available prior to delivery in 74 cases (55.2% of women tested at admission), on useful time to carry out all known strategies to prevent vertical transmission of HIV infection. In 28 cases (20.8%) serological diagnosis was received after delivery, but on time for an eventually promptly starting of antiretroviral prophylaxis on the newborn. The receipt of test results after 12 hours from delivery occurred in 32 cases (23.9%) and they were very late to enactment the necessary prevention strategies. Conclusion We found an important percentage of pregnant women reach to delivery without a HIV screening performed during pregnancy. This underline the necessary close surveillance that nurses, midwives and obstetrician must keep and the importance of HIV testing suggestion during pregnancy in order to achieve a timely HIV assessment, performed in the early stages of pregnancy. The attention of maternity hospital personnel, registering prenatal records, show crucial importance for a complete preventive intervention against HIV transmission to the newborn. Our study emphasizes the importance of a promptly HIV testing results and suggest the possibility of presence of rapid testing in delivery rooms, in order to carry out the prevention strategies soon as possible during labour in positive cases. We want to underline the recent up-date of international guidelines, where HIV testing is simplified adopting an opt-out approach and the abolition of a specific written informed consent in order to permit a major efficiency of pre-natal care ad an better manage of high risk pregnancies.

Objective: The administration of highly active antiretroviral therapy (HAART) to HIV-infected pregnant women raised the question of the association with adverse pregnancy outcomes. There is limited information regarding use of HAART during pregnancy in resource-constrained settings, where an increasing number of women need HAART administration. Our aim was to explore the association between HAART administration and adverse pregnancy outcomes and low birth weight (LBW)in a resource-limited setting. Methods: A retrospective cohort of HIV-infected pregnant women enrolled in the programme of Prevention of Mother-to- Child Transmission between 2003 and 2007 in Ouagadougou, Burkina Faso, was considered. Age, CD4+ T lymphocyte count, type and timing of antiretroviral drugs administration, pregnancy outcome, paediatric infection and birth weight were evaluated. Data were analysed using univariate analysis and binary logistic regression. Results: 678 HIV-infected were enrolled: 395 women received prophylactic regimen and 283 HAART regimen (115 started prior to conception, 168 started after the first trimester). Statistical analysis raised CD4+ T cell count

Obiettivo: Il progressivo estendersi dell’impiego della terapia antiretrovirale ad elevata efficacia ( Higly Active Antiretroviral Therapy-HAART) nelle donne HIV positive in gravidanza pone l’interrogativo circa i possibili effetti avversi di tale terapia sullo sviluppo del prodotto del concepimento. Dati ottenuti da coorti di numerosità limitata nei Paesi occidentali non hanno evidenziato differenze statisticamente significative rispetto alla popolazione generale. Il presente studio osserva l’impatto della HAART sulle gravidanze di donne HIV positive in un Paese a risorse limitate, in cui è presente una maggiore sieroprevalenza e necessità di ampliamento dell’accesso ai farmaci antiretrovirali (ARV). Materiali e metodi: Lo studio ha analizzato le gravidanze di 687 donne HIV positive in Burkina Faso, in diverso regime di somministrazione di farmaci ARV (395 in profilassi antiretrovirale, 115 in regime HAART da prima del concepimento, 168 in HAART iniziata successivamente il primo trimestre). Sono stati raccolti i dati relativi a: età, sierostato, conta dei linfociti T CD4+, tipo e timing di somministrazione di farmaci ARV, tipo di outcome e peso alla nascita; successivamente elaborati in analisi univariata e multivariata tramite modello di regressione logistica binaria utilizzando età, tipo di somministrazione di farmaci ARV e conta di linfociti T CD4+ come variabili predittive per esiti avversi. Risultati: L’analisi ha mostrato come unico fattore di rischio statisticamente significativo per outcome avverso di gravidanza (decesso materno, aborto, nato morto) uno stato di immunodepressione materna avanzata, ovvero una conta di linfociti T CD4+

Congenital cytomegalovirus (CMV) infection is the leading non-genetic cause of sensori-neural hearing loss and neurodevelopmental sequelae. Despite these alarming facts, the general public healthcare system is often not aware of CMV and not enough is done to prevent congenital CMV infection.We describe the clinical and laboratory monitoring of a case with primary CMV infection occurring before the fi rst trimester of gestation. Specifi c literature review is included in order to point out major goals achieved in the diagnosis and prognosis of congenital CMV infection and the many questions still unanswered. Serological diagnosis of primary CMV infection was performed based on serum-CMV specifi c-IgM anti bodies, combined with low avidity anti-CMV IgG antibodies. The maternal infection was asymptomatic, as it is for most infections in immunocompetent patients. Therefore, disclosing primary infection depended on specifi c serological tests during the initial period of pregnancy (before weeks 12 – 16 of gestation). The invasive (amniocentesis) and non-invasive (ultrasonographic examination) prenatal tests, carried out at 21 weeks gestation, revealed a severe CMV infection in a fetus small for gestational age with ventriculomegaly. The presence of overt ultrasound abnormalities combined with high viral load in the amniotic fl uid sampled at the appropriate times was highly suggestive of an unfavourable prognosis. The autopsy performed on the fetus confi rmed severe disseminated CMV infection with histological brain damage.