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Introduction: Premature rupture of membranes (PROM) before 37 weeks of gestation is a common obstetrical event, whose pathophysiology is still poorly understood. Our objective was to study the mechanical strength of fetal membranes in women with a clinical risk factor for preterm premature rupture of membranes (PPROM). Methods: We included, in a prospective, descriptive, single-center study, patients scheduled for cesarean section at term (≥ 37 weeks of gestation). For each patient, we performed uniaxial tensile tests on fetal membranes with a universal testing machine equipped with a force sensor (EZ20®, Lloyds), allowing the recording of an applied force/time curve. We collected maximum force (Fmax), maximum stress (σMax), and Young's modulus of elasticity. The thickness of each membrane sample was also measured. We compared the values obtained according to certain clinical risk factors for PPROM such as age, body mass index, gravidity, parity, a history of PPROM or preterm birth, smoking, gestational diabetes, geographic origin, and socioeconomic level. Results: We analyzed 31 patients and found no association between the studied risk factors and σMax. Fmax was lower in primiparous patients (p = 0.02) but increased with patient parity (p = 0.005). Gestational diabetes was associated with a higher Fmax (p = 0.033) and sub-Saharan geographical origin with a greater thickness (p = 0.0043). As membrane thickness increased, σMax (p = 0.009) and Young's modulus decreased (p = 0.037). Conclusion: Primiparous patients have lower membrane mechanical strength than patients who have had one or more deliveries. Mechanically, the thicker membranes are less rigid and less resistant. [ABSTRACT FROM AUTHOR]

L'infection congénitale à cytomégalovirus (CMV) touche près de 1 % des nouveau-nés avec un risque de séquelles de 17 à 20 %. La primo-infection maternelle au cours du premier trimestre de grossesse représente le facteur de risque le plus important d'atteintes sévères. Afin de prévenir la primo-infection maternelle, des stratégies de prévention primaire (mesures d'hygiène et d'information) ont démontré leur efficacité mais elles demeurent insuffisantes. Bien qu'il ne soit pas encore recommandé par les autorités de santé, le dépistage permet de détecter au plus tôt les cas de primo-infection maternelle afin de mettre en place une prévention de la transmission par l'administration de valaciclovir. Cette stratégie a démontré son efficacité en réduisant la transmission materno-fœtale du CMV de 70 %. Le dépistage repose sur la réalisation d'une sérologie CMV (IgG et IgM), complétée par une avidité des IgG en cas de présence d'IgM. Il est essentiel que le dépistage et l'initiation du traitement soient les plus précoces possible pour optimiser l'efficacité de cette stratégie. La PCR sur liquide amniotique, proposée dans le cadre d'une primo-infection maternelle du premier trimestre, permet de faire le diagnostic d'infection fœtale. Elle est également indiquée en cas d'anomalies fœtales détectées à l'échographie, évocatrices de fœtopathie infectieuse. L'infection à CMV chez le nouveau-né sera objectivée par une PCR sur salive ou urine et un traitement par valganciclovir pourra être initié en cas d'infection congénitale symptomatique. Congenital cytomegalovirus (CMV) infection affects almost 1 % of newborns, with a risk of sequelae of 17-20 %. Primary maternal infection during the first trimester of pregnancy is the most significant risk factor for severe disease. To prevent primary maternal infection, primary prevention strategies (hygiene and information measures) have been shown to be effective but are still insufficient. Although not yet recommended by the health authorities, screening enables cases of primary maternal infection to be detected as early as possible, so that transmission can be prevented by administering valaciclovir. This strategy has proved effective, reducing maternal-fetal transmission of CMV by 70 %. Screening is based on CMV serology (IgG and IgM), supplemented by IgG avidity testing if IgM are present. It is essential that screening and initiation of treatment should be as early as possible to optimize the efficacy of this strategy. PCR on amniotic fluid, proposed in the case of a first trimester maternal primary infection, can be used to diagnose fetal infection. It is also indicated in the event of abnormalities detected on ultrasound. CMV infection in newborns can be confirmed by PCR on saliva or urine, and treatment with valaganciclovir can be initiated in cases of symptomatic congenital infection. [ABSTRACT FROM AUTHOR]

Background: Congenital CMV infection is the leading cause of neonatal neurological deficit. We herein studied in vitro and ex vivo the potential of the hyperimmune globulin Cytotect CP® (Biotest, Germany) for congenital infection prevention and treatment. Methods: In vitro neutralization assays were conducted in fibroblasts and retinal epithelial cells on the CMV strains TB40/E and VHL/E to determine the 50% and 90% neutralizing doses (ND50 and ND90). The toxicity was assessed by measuring LDH release. Ex vivo assays were conducted in first-trimester villi explants with the TB40/E strain, namely, neutralization assays, the prevention of villi infection, and the inhibition of viral replication in infected villi. Viability was assessed by β-HCG quantification in supernatants. Results: The in vitro neutralization tests showed that Cytotect CP®® inhibits the development of infection foci (DN50: 0.011–0.014 U/mL for VHL/E and 0.032–0.033 U/mL for TB40E) without any toxicity. In the ex vivo neutralization assays, the DN50 were 0.011 U/mL on day 7 and 0.093 U/mL on day 14. For the prevention of villi infection, the EC50 was 0.024 U/mL on day 7. Cytotect-CP® did not inhibit viral growth in infected villi. No impact on villi viability was observed. Conclusions: These results sustained that Cytotect CP® has the potential to prevent CMV congenital infection. [ABSTRACT FROM AUTHOR]

Objectives: Congenital cytomegalovirus (CMV) infection is the most common congenital infection and the leading cause of infectious neurosensorial disability in newborns. We wanted to organize the management of women from the beginning of pregnancy allowing access to antenatal treatment with valaciclovir, recognized since 2020 as limiting materno-fetal transmission. To this end, we set up and evaluated the interest of systematic screening for CMV infection in our maternity. We wanted to organize care for women from the very start of pregnancy., Methods: Retrospective and comparative descriptive study carried out at the CHRU de Limoges from July 2017 to December 2019 (targeted screening), then from January 2020 to June 2022, during which period we implemented systematized screening by iterative serologies at the 3rd, 6th, 8th months and before delivery. Our main evaluation criteria were the seroprevalence of CMV infection and the rate of congenital infection. We then described our cases of infection (primary or secondary) during pregnancy., Results: CMV seroprevalence in our pregnant women increased significantly from 52.7% (779/1478 women screened) to 58.4% (3852/6599 women screened) between the 2 study periods (P=0.04). We diagnosed 11 infections during the first part of the study vs. 27 during the second, with a significant increase in primary infections from 0.14% (9/6524 births) to 0.37% (24/6426 births) (P=0.008). Only 3 secondary infections were diagnosed during the second study period. The rate of congenital infections remained stable between the 2 study periods (6 children/6524=0.09% vs. 8 children/6426=0.12%; P=0.57)., Conclusion: Our results confirmed the interest of screening for CMV infection, while modifying the screening strategy we had initiated., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)