Fetal Cytomegalovirus Associated Intraventricular Hemorrhage: A Rare Prenatal Complication

Abstract

Intraventricular hemorrhage (IVH) is an uncommon manifestation of congenital cytomegalovirus (CMV) infection. We report a case of primary CMV infection associated with preterm labor as well as fetal anemia, thrombocytopenia, and IVH. The finding of unexplained IVH on ultrasound provided an indication for testing of congenital infection. Our case indicates the need for detailed sonographic imaging in pregnancies complicated by preterm labor, as the integration of ultrasound diagnosis can significantly impact management and improve perinatal outcomes.

Keywords

cytomegalovirus - intraventricular hemorrhage - fetal ultrasound - prenatal diagnosis - congenital infection

Publication History

Received: 03 April 2025

Accepted: 21 April 2025

Accepted Manuscript online:
23 May 2025

Article published online:
11 June 2025

• References

• 1 Chatzakis C, Ville Y, Makrydimas G, Dinas K, Zavlanos A, Sotiriadis A. Timing of primary maternal cytomegalovirus infection and rates of vertical transmission and fetal consequences. Am J Obstet Gynecol 2020; 223 (06) 870-883.e11
• 2 Ornoy A, Diav-Citrin O. Fetal effects of primary and secondary cytomegalovirus infection in pregnancy. Reprod Toxicol 2006; 21 (04) 399-409
• 3 Malinger G, Lev D, Zahalka N. et al. Fetal cytomegalovirus infection of the brain: the spectrum of sonographic findings. AJNR Am J Neuroradiol 2003; 24 (01) 28-32
• 4 Leijser LM, de Vries LS. Chapter 8 - Preterm brain injury: Germinal matrix–intraventricular hemorrhage and post-hemorrhagic ventricular dilatation. In: de Vries LS, Glass HC. eds. Handbook of Clinical Neurology. Vol 162. Neonatal Neurology. Elsevier; 2019: 173-199
• 5 Kenet G, Kuperman AA, Strauss T, Brenner B. Neonatal IVH–mechanisms and management. Thromb Res 2011; 127 (Suppl. 03) S120-S122
• 6 Dunbar MJ, Woodward K, Leijser LM, Kirton A. Antenatal diagnosis of fetal intraventricular hemorrhage: systematic review and meta-analysis. Dev Med Child Neurol 2021; 63 (02) 144-155
• 7 Enders M, Daiminger A, Exler S, Ertan K, Enders G, Bald R. Prenatal diagnosis of congenital cytomegalovirus infection in 115 cases: a 5 years' single center experience. Prenat Diagn 2017; 37 (04) 389-398
• 8 Rawlinson WD, Boppana SB, Fowler KB. et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis 2017; 17 (06) e177-e188
• 9 Davis NL, King CC, Kourtis AP. Cytomegalovirus infection in pregnancy. Birth Defects Res 2017; 109 (05) 336-346
• 10 Liesnard C, Donner C, Brancart F, Gosselin F, Delforge ML, Rodesch F. Prenatal diagnosis of congenital cytomegalovirus infection: prospective study of 237 pregnancies at risk. Obstet Gynecol 2000; 95 (6 Pt 1): 881-888
• 11 Pomar L, Contier A, Stojanov M. et al. Contribution of fetal blood sampling to determining the prognosis of congenital cytomegalovirus infections: a case-cohort study in Switzerland. Am J Obstet Gynecol 2024; 231 (06) 643.e1-643.e12
• 12 Uenaka M, Morizane M, Tanimura K. et al. Histopathological analysis of placentas with congenital cytomegalovirus infection. Placenta 2019; 75: 62-67
• 13 Pesch MH, Mowers J, Huynh A, Schleiss MR. Intrauterine fetal demise, spontaneous abortion and congenital cytomegalovirus: a systematic review of the incidence and histopathologic features. Viruses 2024; 16 (10) 1552
• 14 Bayley N. Comparisons of mental and motor test scores for ages 1–15 months by sex, birth order, race, geographical location, and education of parents. Child Dev 1965; 36 (02) 379-411