Viral invasion of the amniotic cavity (VIAC) in the midtrimester of pregnancy

Figures & data

Table I.  Clinical characteristics of the study population.

	Viral PCR in amniotic fluid		p
	Negative (n = 713)	Positive (n = 16)
Maternal age (years)	36 (35–38)	36 (33–37)	0.4
Ethnicity
Caucasian	699 (98%)	16 (100%)	0.9
African American	6 (0.8%)	--
Asian	3 (0.4%)	--
Others	5 (0.7%)	--
Nulliparous	292 (41%)	8 (50%)	0.5
Previous spontaneous preterm delivery	19 (2.7%)	--	1.0
GA at amniocentesis (weeks)	16.3 (15.9–17.0)	16.4 (15.8–20.4)	0.6
AF white blood cell count (cells/mL)	3 (2–6)	3 (2–7.5)	0.9
AF glucose (mg/dL)	48 (44–52)	50 (44–54)	0.3
Amniocentesis-to-delivery interval (weeks)	23 (21–24)	22.5 (18–24)	0.3
GA at delivery (weeks)	39.6 (38.6–40.6)	39.5 (38.8–40.9)	0.8
Birth weight (g)	3340 (3060–3600)	3320 (3071–3780)	0.7

Value expressed as median (inter-quartile) or number (percent).

GA, gestational age; AF, amniotic fluid.

Table II.  Number of viral copies in the amniotic fluid and maternal blood of the 16 cases positive for viral DNA in the amniotic fluid.

Virus	AF copies/mL	AF copies/cell	Maternal plasma copies/mL	Maternal plasma copies/cell
HHV6	13,000	1.5	25,300	2.0
	2700	0.8	Negative	Negative
	280	0.7	150	0.6
	30,000	0.8	25,300	0.7
	2600	0.9	13,100	1.7
	15,000	1.1	50,000	2.5
	765,000	2.9	3500	1.5
PV B19	1450		Negative
	15		Negative
HCMV	20		Negative
	60		Negative
	1485		Negative
	91,950		Negative
	99,700		Negative
	36,650		Negative
EBV	15		Negative

Table III.  Amniotic fluid and maternal blood cytokine concentrations.

		Viral PCR in amniotic fluid		p value
		Negative (n = 713)	Positive (n = 16)
Amniotic fluid	IL-6 (pg/mL)	413 (214-880)*	1031 (209-1696)	0.09
	IP-10 (pg/mL)	595 (410-972)^†	736 (428-1577)	0.6
Maternal blood	IL-6 (pg/mL)	0.70 (0.55-0.97)^‡	0.66 (0.49-0.88)	0.4
	IP-10 (pg/mL)	85.4 (67.3-110.7)^‡	93.5 (70.9-146.8)	0.2

Values are expressed as median (inter-quartile).

*n = 710.

^†n = 704.

^‡n = 632.

Table IV.  Summary of studies reporting recovery of viral nucleic acids in the amniotic fluid in the midtrimester.

Reference	Population	n	Viral prevalence n (%)	Virus Recovered (PCR or culture)	Complications
McLean et al. (1995 [100])	Low-risk	277	0	--	--
Wenstrom et al. (1998 [115])	Low-risk: normal outcome	60	9 (15)	Adenovirus (5), CMV (3), Parvovirus B19 (1)	No significant difference in the prevalence of viruses between normal and poor outcome groups
	Low-risk: poor outcome^†	62	5 (8)	Adenovirus (4), HSV (1)
Van de Veyver et al. (1998 [116])	Low-risk	154	4 (2.6)	Adenovirus (3), CMV (1)	--
	High-risk	303*	124 (41)	Adenovirus (74), CMV (30), enterovirus (22), HSV (9), parvovirus (8), EBV (4), RSV (2)	Non-immune hydrops, ventriculomegaly, growth restriction, stuck-twin syndrome, hepatic calcifications, ascites, myocarditis, pericardial effusion, hydramnios
Burguete et al. (1999 [117])	Fetuses with and without anomalies	238	64 (26.9)	Papillomavirus (25/208, 12%) Adenovirus (64/238, 27%) CMV (32/183,18%)	Higher prevalence of viruses in amniotic fluid in women with preterm labor and premature rupture of membranes
Baschat et al. (2000 [272])	Low-risk	240	20 (8.9)	Among all pregnancies: adenovirus (39), enterovirus (5), CMV (3), RSV (1), EBV (1), parvovirus (1)	Higher prevalence of viruses in CNS malformations (7), SGA (4), multiple malformations (4)
	Fetal complications^‡	138	27 (19.6)
Petrikovsky et al. (2003 [119])	Fetuses with and without anomalies	474	9 (1.9)	Cultures positive for CMV (5), adenovirus (2), enterovirus (2)	Higher prevalence of viruses in the presence of fetal anomalies
Baschat et al. (2003 [101])	Low-risk	686	44 (6.4)	Adenovirus (37), CMV (5), EBV (2), enterovirus (2), RSV (1)	--
Reddy et al. (2005 [118])	Normal US	287	24 (8.4)	Adenovirus, enterovirus, CMV, PV B19	Higher prevalence of viruses in fetal anomalies, SGA, hydrops
	Abnormal US	136	33 (24)

*371 specimen samples: amniotic fluid (n = 253), fetal blood at cordocentesis (n = 42), cord blood at the time of delivery (n = 18), fetal ascites (n = 8), pleural effusion (n = 40).

^†Pregnancies lost within 30 days of genetic amniocentesis.

^‡Fetal anomalies, SGA, proven maternal infections; samples obtained from amniotic fluid, fetal blood or pleural fluid.

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