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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2017; 39(05): 235-248
DOI: 10.1055/s-0037-1603450
Systematic Review
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Zika Virus Infection in Pregnant Women and Microcephaly[*]

Infecção do vírus Zika em gestantes e microcefalia*
Geraldo Duarte
1   Universidade de São Paulo, Ribeirão Preto, SP, Brazil
,
Antonio Fernandes Moron
2   Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Artur Timerman
3   Hospital Professor Edmundo Vasconcelos, São Paulo, SP, Brazil
,
César Eduardo Fernandes
4   Faculdade de Medicina do ABC, Santo André, SP, Brazil
,
Corintio Mariani Neto
5   Hospital Maternidade Leonor Mendes de Barros, São Paulo, SP, Brazil
,
Gutemberg Leão de Almeida Filho
6   Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
,
Heron Werner Junior
7   Alta Excelência Diagnóstica, Rio de Janeiro, RJ, Brazil
,
Hilka Flavia Barra do Espírito Santo
8   Universidade Federal do Amazonas, Manaus, AM, Brazil
,
João Alfredo Piffero Steibel
9   Pontifícia Universidade Católica, Porto Alegre, RS, Brazil
,
João Bortoletti Filho
2   Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Juvenal Barreto Borriello de Andrade
10   Consultório Médico Juvenal Barreto Borriello de Andrade, São Paulo, SP, Brazil
,
Marcelo Burlá
11   Clínica Marcelo Burlá, Rio de Janeiro, RJ Brazil
,
Marcos Felipe Silva de Sá
1   Universidade de São Paulo, Ribeirão Preto, SP, Brazil
,
Newton Eduardo Busso
12   Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
,
Paulo César Giraldo
13   Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Renato Augusto Moreira de Sá
14   Universidade Federal Fluminense, Niterói, RJ, Brazil
,
Renato Passini Junior
13   Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Rosiane Mattar
2   Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Rossana Pulcineli Vieira Francisco
15   Universidade de São Paulo, São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

22 January 2017

21 February 2017

Publication Date:
02 June 2017 (online)

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Abstract

From the discovery of the Zika virus (ZIKV) in 1947 in Uganda (Africa), until its arrival in South America, it was not known that it would affect human reproductive life so severely. Today, damage to the central nervous system is known to be multiple, and microcephaly is considered the tip of the iceberg. Microcephaly actually represents the epilogue of this infection's devastating process on the central nervous system of embryos and fetuses. As a result of central nervous system aggression by the ZIKV, this infection brings the possibility of arthrogryposis, dysphagia, deafness and visual impairment. All of these changes of varying severity directly or indirectly compromise the future life of these children, and are already considered a congenital syndrome linked to the ZIKV. Diagnosis is one of the main difficulties in the approach of this infection. Considering the clinical part, it has manifestations common to infections by the dengue virus and the chikungunya fever, varying only in subjective intensities. The most frequent clinical variables are rash, febrile state, non-purulent conjunctivitis and arthralgia, among others. In terms of laboratory resources, there are also limitations to the subsidiary diagnosis. Molecular biology tests are based on polymerase chain reaction (PCR) with reverse transcriptase (RT) action, since the ZIKV is a ribonucleic acid (RNA) virus. The RT-PCR shows serum or plasma positivity for a short period of time, no more than five days after the onset of the signs and symptoms. The ZIKV urine test is positive for a longer period, up to 14 days. There are still no reliable techniques for the serological diagnosis of this infection. If there are no complications (meningoencephalitis or Guillain-Barré syndrome), further examination is unnecessary to assess systemic impairment. However, evidence is needed to rule out other infections that also cause rashes, such as dengue, chikungunya, syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes. There is no specific antiviral therapy against ZIKV, and the therapeutic approach to infected pregnant women is limited to the use of antipyretics and analgesics. Anti-inflammatory drugs should be avoided until the diagnosis of dengue is discarded. There is no need to modify the schedule of prenatal visits for pregnant women infected by ZIKV, but it is necessary to guarantee three ultrasound examinations during pregnancy for low-risk pregnancies, and monthly for pregnant women with confirmed ZIKV infection. Vaginal delivery and natural breastfeeding are advised.

Resumo

Desde a descoberta do vírus Zika (VZIK) em 1947 em Uganda, na África, até sua chegada na América do Sul, não se tinha notícia de que ele seria capaz de comprometer a vida reprodutiva em humanos de forma tão severa. Hoje, sabe-se que os danos sobre o sistema nervoso central são múltiplos, e a microcefalia é considerada a ponta do iceberg, visto que na realidade ela representa o epílogo de um processo devastador desta infecção sobre o sistema nervoso central do embrião e do feto. Em decorrência da agressão do sistema nervoso central pelo VZIK, esta infecção pode provocar artrogripose, disfagia, surdez e comprometimento visual. Todas estas alterações, de gravidade variável, direta ou indiretamente comprometem a vida futura dessas crianças, já sendo considerada uma síndrome congênita ligada ao VZIK. Uma das principais dificuldades na abordagem dessa infecção é relativa ao diagnóstico. Considerando a parte clínica, observa-se que ela apresenta manifestações comuns às infecções pelos vírus da dengue e da febre chikungunya, variando apenas em suas intensidades subjetivas. As variáveis clínicas mais frequentes são o exantema, febrícula, conjuntivite não purulenta e artralgia. No tocante aos recursos laboratoriais, também existem limitações ao diagnóstico subsidiário. As provas de biologia molecular se fundamentam na reação em cadeia da polimerase (RCP) com ação da transcriptase reversa (TT), visto que o VZIK é um vírus ácido ribonucleico (ARN). A TR-RCP apresenta positividade sérica ou plasmática por um período curto de tempo, não ultrapassando cinco dias após início dos sinais e sintomas. Esta pesquisa do VZIK na urina fica positiva por período mais prolongado, chegando a 14 dias. Ainda não existem técnicas seguras para diagnóstico sorológico dessa infecção. Não havendo complicações (meningoencefalite ou síndrome de Guillain-Barré), dificilmente são necessários mais exames complementares para avaliar o comprometimento sistêmico. No entanto, são necessárias provas para descartar as outras infecções que causam exantema, como dengue, chikungunya, sífilis, toxoplasmose, citomegalovírus, rubéola e herpes. Sabe-se que não existe terapia antiviral específica contra o VZIK, e a abordagem terapêutica de gestantes portadoras da infecção limita-se ao uso de antitérmicos e analgésicos. Orienta-se evitar anti-inflamatórios até que o diagnóstico de dengue seja descartado. Sobre a condução do pré-natal, não há necessidade de modificar o cronograma de consultas pré-natais para gestantes que foram infectadas pelo VZIK, mas é necessária a garantia de três exames ecográficos durante a gravidez para gestantes de baixo risco, e mensais para a gestante com infecção confirmada pelo VZIK. A via de parto é vaginal, e está liberado o aleitamento natural.

Keywords

pregnancy complications - Zika virus - arbovirus infections - microcephaly/ultrasonography - real-time polymerase chain reaction - deafness/ etiology - blindness/ etiology

Palavras-chave

complicações na gravidez - vírus da Zika - infecções por arbovírus - microcefalia/ultrassonografia - reação em cadeia da polimerase em tempo real - surdez/ etiologia - cegueira/ etiologia

* This review is part of the Series, Guidelines and Recommendations of the Brazilian Federation of Gynecology and Obstetrics Associations - FEBRASGO, and was prepared by the National Provisional Specialized Commission for the Study of Zika Virus, Pregnancy and Microcephaly.


 

  • References

  • 1 Brasil. Ministério da Saúde do Brasil. Ministério da Saúde confirma relação entre vírus Zika e microcefalia [Internet]. Brasília (DF): Ministério da Saúde; 2015; [cited in Dec 22, 2015]. Available at: http://portalsaude.saude.gov.br/index.php/cidadao/principal/agencia-saude/21014-ministerio-da-saude-confirma-relacao-entre-virus-zika-e-microcefalia
    PubMedGoogle Scholar
  • 2 European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment: Microcephaly in Brazil potentially linked to the Zika virus epidemic, 2015. Stockholm: ECDC; 2015
    Google Scholar
  • 3 Mlakar J, Korva M, Tul N. , et al. Zika virus associated with microcephaly. N Engl J Med 2016; 374 (10) 951-958
    CrossrefPubMedGoogle Scholar
  • 4 Centro de Operações de Emergências em Saúde Pública Sobre Microcefalias (COESP). Informe Epidemiológico N° 23. Semana Epidemiológica 16/2016 (17/04 a 23/04/2016). Monitoramento dos casos de microcefalia no Brasil [Internet]. [citado Apr 24, 2016]. Available at: http://portalsaude.saude.gov.br/images/pdf/2016/abril/27/COES-Microcefalias—Informe-Epidemiol–gico-23–SE-16-2016–25abril2016-20h07.pdf
    PubMed
  • 5 Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika Virus and Birth defects–Reviewing the Evidence for Causality. N Engl J Med 2016; 374 (20) 1981-1987
    CrossrefPubMedGoogle Scholar
  • 6 Ministério da Saúde (MS) Secretaria de Vigilância em Saúde, Departamento de Vigilância das Doenças Transmissíveis. Protocolo de Vigilância e Resposta à Ocorrência de Microcefalia Relacionada à Infecção Pelo Vírus Zika. Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância das Doenças Transmissíveis. Brasília (DF); Ministério da Saúde:1–71, 2015b
    PubMedGoogle Scholar
  • 7 São Paulo State Government. Secretaria de Estado da Saúde, Coordenadoria de Controle de Doenças Centro de Vigilância Epidemiológica, Instituto Adolfo Lutz. Vigilância das microcefalias relacionadas à infecção pelo vírus Zika. São Paulo; SESP-SP:1–13, 2015. [Informe Técnico N° 1 de 14/12/2015]
    Google Scholar
  • 8 Tetro JA. Zika and microcephaly: causation, correlation, or coincidence?. Microbes Infect 2016; 18 (03) 167-168
    CrossrefPubMedGoogle Scholar
  • 9 Schuler-Faccini L, Ribeiro EM, Feitosa IM. , et al; Brazilian Medical Genetics Society–Zika Embryopathy Task Force. Brazilian Medical Genetics Society-Zika Embryopathy Task Force. Possible association between Zika virus infection and microcephaly - Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016; 65 (03) 59-62
    CrossrefPubMedGoogle Scholar
  • 10 Duarte G. Infecção pelo vírus zika durante a gravidez. Femina 2016; 44: 26-48
    PubMedGoogle Scholar
  • 11 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde, Departamento de Vigilância das Doenças Transmissíveis. Protocolo de vigilância e resposta à ocorrência de microcefalia e/ou alterações do sistema nervoso central (SNC). Versão 2. Brasília (DF): Ministério da Saúde; 2016. . p.1–55
    Google Scholar
  • 12 São Paulo State Government. Secretaria de Estado da Saúde. Centro de Vigilância Epidemiológica da SESP-SP. Protocolo de vigilância para gestantes com exantema. São Paulo: Secretaria de Estado da Saúde; 2016
    Google Scholar
  • 13 Olson CK, Iwamoto M, Perkins KM. , et al. Preventing transmission of zika virus in labor and delivery settings through implementation of standard precautions - United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 (11) 290-292
    CrossrefPubMedGoogle Scholar
  • 14 Centers for Disease Control and Prevention (CDC). Zika virus transmission [Internet]. [cited 2015 Dec 18]. Available from: http://www.cdc.gov/zika/transmission/index.html
    PubMedGoogle Scholar
  • 15 World Health Organization (WHO). Pregnancy management in the context of Zika virus. Interim guidance uptodate. Geneva: WHO; 2016. WHO/ZIKV/MOC/16.2; page 1–7
    Google Scholar
  • 16 Duarte G. Cartilha sobre a infecção pelo vírus Zika para orientação das gestantes. Texto elaborado pela Comissão Nacional Especializada Provisória Zika Vírus, Gravidez e Microcefalia. Cartilha sobre a infecção pelo vírus Zika para orientação das gestantes [Internet]. [cited 2017 Fev 18]. Available at: http://www.febrasgo.org.br/site/wp-content/uploads/2016/02/Cartilha-sobre-a-infeccao-pelo-virus-Zika-para-orientacao-das-gestantes.pdf
    PubMedGoogle Scholar
  • 17 Kuno G, Chang GJ, Tsuchiya KR, Karabatsos N, Cropp CB. Phylogeny of the genus Flavivirus. J Virol 1998; 72 (01) 73-83
    CrossrefPubMedGoogle Scholar
  • 18 Klema VJ, Padmanabhan R, Choi KH. Flaviviral Replication Complex: Coordination between RNA Synthesis and 5'-RNA Capping. Viruses 2015; 7 (08) 4640-4656
    CrossrefPubMedGoogle Scholar
  • 19 Dick GW, Kitchen SF, Haddow AJ. Zika virus. I. Isolations and serological specificity. Trans R Soc Trop Med Hyg 1952; 46 (05) 509-520
    CrossrefPubMedGoogle Scholar
  • 20 Imperato PJ. The convergence of a virus, mosquitoes, and human travel in globalizing the zika epidemic. J Community Health 2016; 41 (03) 674-679
    CrossrefPubMedGoogle Scholar
  • 21 Enfissi A, Codrington J, Roosblad J, Kazanji M, Rousset D. Zika virus genome from the Americas. Lancet 2016; 387 (10015): 227-228
    CrossrefPubMedGoogle Scholar
  • 22 Faria NR, Azevedo RdoS, Kraemer MU. , et al. Zika virus in the Americas: Early epidemiological and genetic findings. Science 2016; 352 (6283): 345-349
    CrossrefPubMedGoogle Scholar
  • 23 Naccache SN, Thézé J, Sardi SI. , et al. Distinct zika virus lineage in Salvador, Bahia, Brazil. Emerg Infect Dis 2016; 22 (10) 1788-1792
    CrossrefPubMedGoogle Scholar
  • 24 Pan American Health Organization (PAHO). Alerta Epidemiológica-Síndrome neurológico, anomalías congénitas e infección por virus Zika. Implicaciones para la salud pública en las Américas [Internet]. Washington: Pan American Health Organization; 2015. [cited 2016 Nov 26]. Available at: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=32404&lang=es
    PubMedGoogle Scholar
  • 25 Kleber de Oliveira W, Cortez-Escalante J, De Oliveira WT. , et al. Increase in Reported Prevalence of Microcephaly in Infants Born to Women Living in Areas with Confirmed Zika Virus Transmission During the First Trimester of Pregnancy–Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016; 65 (09) 242-247
    CrossrefPubMedGoogle Scholar
  • 26 Musso D, Cao-Lormeau VM, Gubler DJ. Zika virus: following the path of dengue and chikungunya?. Lancet 2015; 386 (9990): 243-244
    CrossrefPubMedGoogle Scholar
  • 27 França GV, Schuler-Faccini L, Oliveira WK. , et al. Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation. Lancet 2016; 388 (10047): 891-897
    CrossrefPubMedGoogle Scholar
  • 28 Miranda-Filho DdeB, Martelli CM, Ximenes RA. , et al. Initial Description of the Presumed Congenital Zika Syndrome. Am J Public Health 2016; 106 (04) 598-600
    CrossrefPubMedGoogle Scholar
  • 29 de Paula Freitas B, de Oliveira Dias JR, Prazeres J. , et al. Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazil. JAMA Ophthalmol 2016; 134 (05) 529-535
    CrossrefPubMedGoogle Scholar
  • 30 Oster AM, Russell K, Stryker JE. , et al. Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus–United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 (12) 323-325
    CrossrefPubMedGoogle Scholar
  • 31 Petersen EE, Meaney-Delman D, Neblett-Fanfair R. , et al. Update: Interim guidance for preconception counseling and prevention of sexual transmission of zika virus for persons with possible zika virus exposure – United States, September 2016. MMWR Morb Mortal Wkly Rep 2016; 65 (39) 1077-1081
    CrossrefPubMedGoogle Scholar
  • 32 World Health Organization (WHO). Prevention of sexual transmission of Zika virus. Interim guidance update. 2016 ; WHO/ZIKV/MOC/16.1 Rev.3, page: 1–5. [cited 2017 Jan 8]. Available from: http://apps.who.int/iris/bitstream/10665/204421/1/WHO_ZIKV_MOC_16.1_eng.pdf?ua=1
    PubMedGoogle Scholar
  • 33 Grischott F, Puhan M, Hatz C, Schlagenhauf P. Non-vector-borne transmission of Zika virus: A systematic review. Travel Med Infect Dis 2016; 14 (04) 313-330
    CrossrefPubMedGoogle Scholar
  • 34 Nogueira ML, Estofolete CF, Terzian AC. , et al. Zika virus infection and solid organ transplantation: A new challenge. Am J Transplant 2017; 17 (03) 791-795
    CrossrefPubMedGoogle Scholar
  • 35 Musso D, Nhan T, Robin E. , et al. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveill 2014; 19 (14) 20761
    CrossrefPubMedGoogle Scholar
  • 36 Cunha MS, Esposito DL, Rocco IM. , et al. First complete genome sequence of Zika virus (Flaviviridae, Flavivirus) from an autochthonous transmission in Brazil. Genome Announc 2016; 4 (02) 16-32
    CrossrefPubMedGoogle Scholar
  • 37 Cardoso CW, Paploski IA, Kikuti M. , et al. Outbreak of exanthematous illness associated with Zika, Chikungunya, and Dengue viruses, Salvador, Brazil. Emerg Infect Dis 2015; 21 (12) 2274-2276
    CrossrefPubMedGoogle Scholar
  • 38 Duffy MR, Chen TH, Hancock WT. , et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 2009; 360 (24) 2536-2543
    CrossrefPubMedGoogle Scholar
  • 39 Piersen TC, Diamond MS. Flaviviruses. In: Knipe DM, Howley PM. , eds. Fields Virology. Philadelphia, PA: Wolters Kluver/Lippincott/Williams & Wilkins; 2013. . p. 747–95
    Google Scholar
  • 40 Centers for Disease Control and Prevention (CDC). Interim guidance for zika virus testing of urine - United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 (18) 474
    CrossrefPubMedGoogle Scholar
  • 41 Centers for Disease Control and Prevention (CDC). Trioplex Real-time RT-PCR Assay. For use under an emergency use authorization only [Internet]. [cited 2016 Nov 22]. Available from: http://www.fda.gov/downloads/MedicalDevices/Safety/EmergencySituations/UCM491592.pdf
    PubMedGoogle Scholar
  • 42 Centers for Disease Control and Prevention (CDC). Diagnostic testing [Internet]. [cited 2016 Nov 22]. Available from http://www.cdc.gov/zika/hc-providers/diagnostic.html
    PubMedGoogle Scholar
  • 43 Oehler E, Watrin L, Larre P. , et al. Zika virus infection complicated by Guillain-Barre syndrome--case report, French Polynesia, December 2013. Euro Surveill 2014; 19 (09) 20720
    CrossrefPubMedGoogle Scholar
  • 44 Zara AL, Santos SM, Fernandes-Oliveira ES, Carvalho RG, Coelho GE. [Aedes aegypti control strategies: a review]. Epidemiol Serv Saude 2016; 25 (02) 391-404
    PubMedGoogle Scholar
  • 45 Centro de Operações de Emergências em Saúde Pública sobre Microcefalias (COES – Microcefalias, 2016) [Internet]. [cited 2017 Jan 19]. Available from: http://combateaedes.saude.gov.br/images/pdf/Informe-Epidemiologico-n57-SE-52_2016-09jan2017.pdf
    PubMed
  • 46 World Health Organization (WHO/OMS). WHO Child Growth Standards: Growth velocity based on weight, length and head circumference. Methods and development. Geneva: World Health Organization. 2009:1–242 [Internet]. [cited 2017 Jan 12]. Available from: http://www.who.int/childgrowth/standards/en/
    PubMedGoogle Scholar
  • 47 World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). Birth Defects Surveillance: A Manual for Programme Managers. Geneva: World Health Organization; 2014. . p.1–116
    Google Scholar
  • 48 Papageorghiou AT, Ohuma EO, Altman DG. , et al; International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Lancet 2014; 384 (9946): 869-879
    CrossrefPubMedGoogle Scholar
  • 49 Intergrowth-21st. Intergrowth-21st Fetal Growth Standards. Accessed in Apr 14, 2016. Available at http://intergrowth21.ndog.ox.ac.uk/
    PubMedGoogle Scholar
  • 50 World Health Organization (WHO). Assessment of infants with microcephaly in the context of Zika virus. Interim guidance. Geneva: WHO; 2016. . WHO/ZIKV/MOC/16.3; Rev. 1, page 1–2
    Google Scholar
  • 51 Papageorghiou AT, Thilaganathan B, Bilardo CM. , et al. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Ultrasound Obstet Gynecol 2016; 47 (04) 530-532
    CrossrefPubMedGoogle Scholar
  • 52 Ashwal S, Michelson D, Plawner L, Dobyns WB. ; Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Practice parameter: Evaluation of the child with microcephaly (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2009; 73 (11) 887-897
    CrossrefPubMedGoogle Scholar
  • 53 Qian X, Nguyen HN, Song MM. , et al. Brain-Region-Specific Organoids Using Mini-bioreactors for Modeling ZIKV Exposure. Cell 2016; 165 (05) 1238-1254
    CrossrefPubMedGoogle Scholar
  • 54 Honein MA, Dawson AL, Petersen EE. , et al; US Zika Pregnancy Registry Collaboration. Birth defects among fetuses and infants of US women with evidence of possible zika virus infection during pregnancy. JAMA 2017; 317 (01) 59-68
    CrossrefPubMedGoogle Scholar
  • 55 Duarte G. Challenges of Zika Virus Infection in Pregnant Women. Rev Bras Ginecol Obstet 2016; 38 (06) 263-265
    Article in Thieme ConnectPubMedGoogle Scholar
  • 56 Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg?. Ultrasound Obstet Gynecol 2016; 47 (01) 6-7
    CrossrefPubMedGoogle Scholar
  • 57 Suy A, Sulleiro E, Rodó C. , et al. Prolonged zika virus viremia during pregnancy. N Engl J Med 2016; 375 (26) 2611-2613
    CrossrefPubMedGoogle Scholar
  • 58 Abuelo D. Microcephaly syndromes. Semin Pediatr Neurol 2007; 14 (03) 118-127
    CrossrefPubMedGoogle Scholar
  • 59 Bailão LA, Osborne NG, Rizzi MC, Bonilla-Musoles F, Duarte G, Bailão TC. Ultrasound markers of fetal infection part 1: viral infections. Ultrasound Q 2005; 21 (04) 295-308
    CrossrefPubMedGoogle Scholar
  • 60 Papageorghiou AT, Kemp B, Stones W. , et al; International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). Ultrasound-based gestational-age estimation in late pregnancy. Ultrasound Obstet Gynecol 2016; 48 (06) 719-726
    CrossrefPubMedGoogle Scholar
  • 61 Leibovitz Z, Daniel-Spiegel E, Malinger G. , et al. Prediction of microcephaly at birth using three reference ranges for fetal head circumference: can we improve prenatal diagnosis?. Ultrasound Obstet Gynecol 2016; 47 (05) 586-592
    CrossrefPubMedGoogle Scholar
  • 62 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
    CrossrefPubMedGoogle Scholar
  • 63 Chervenak FA, Jeanty P, Cantraine F. , et al. The diagnosis of fetal microcephaly. Am J Obstet Gynecol 1984; 149 (05) 512-517
    CrossrefPubMedGoogle Scholar
  • 64 Chervenak FA, Rosenberg J, Brightman RC, Chitkara U, Jeanty P. A prospective study of the accuracy of ultrasound in predicting fetal microcephaly. Obstet Gynecol 1987; 69 (06) 908-910
    PubMedGoogle Scholar
  • 65 Villar J, Giuliani F, Bhutta ZA. , et al; International Fetal and Newborn Growth Consortium for the 21(st) Century (INTERGROWTH-21(st)). Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21(st) Project. Lancet Glob Health 2015; 3 (11) e681-e691
    CrossrefPubMedGoogle Scholar
  • 66 Petersen EE, Polen KN, Meaney-Delman D. , et al. Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure – United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 (12) 315-322
    CrossrefPubMedGoogle Scholar
  • 67 Atkinson B, Thorburn F, Petridou C. , et al. Presence and persistence of zika virus RNA in semen, United Kingdom, 2016. Emerg Infect Dis 2017; 23 (04) 611-615 ; [ Epub ahead of print] DOI: 10.3201/eid2304.161692
    CrossrefPubMedGoogle Scholar
  • 68 McCarthy M. Couples at risk from exposure to Zika virus should consider delaying pregnancy, says CDC. BMJ 2016; 352: i1813
    CrossrefPubMedGoogle Scholar
  • 69 Fuwa K, Hayakawa S. Mechanisms and possible controls of the in utero Zika virus infection: Where is the Holy Grail?. Am J Reprod Immunol 2017; 77 (02) Epub2016Dec14. DOI: 10.1111/aji.12605.
    CrossrefPubMedGoogle Scholar
  • 70 Mansuy JM, Suberbielle E, Chapuy-Regaud S. , et al. Zika virus in semen and spermatozoa. Lancet Infect Dis 2016; 16 (10) 1106-1107
    CrossrefPubMedGoogle Scholar
  • 71 Barzon L, Pacenti M, Franchin E. , et al. Infection dynamics in a traveller with persistent shedding of Zika virus RNA in semen for six months after returning from Haiti to Italy, January 2016. Euro Surveill 2016; 21 (32) 30316
    CrossrefPubMedGoogle Scholar
  • 72 Agência Nacional de Vigilância Sanitária (Anvisa), Ministério da Saúde. Funcionamento dos Bancos de Células e Tecidos Germinativos. Resolução DC/Anvisa, n° 72 de 30/03/2016, Brasília: Anvisa, 2016 [Internet]. Publicada no DOU, n° 62, de 01/04/16, Seção 1: p.103 [cited 2017 Fev 19]. Disponível no ftp://ftp.saude.sp.gov.br/ftpsessp/bibliote/informe_eletronico/2016/iels.abr.16/Iels60/U_RS-MS-ANVISA-RDC-72_300316.pdf
    PubMedGoogle Scholar
  • 73 Oduyebo T, Petersen EE, Rasmussen SA. , et al. Update: Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure – United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 (05) 122-127
    CrossrefPubMedGoogle Scholar
  • 74 Citil Dogan A, Wayne S, Bauer S. , et al. The Zika virus and pregnancy: evidence, management, and prevention. J Matern Fetal Neonatal Med 2017; 30 (04) 386-396
    CrossrefPubMedGoogle Scholar
  • 75 Torres JR, Falleiros-Arlant LH, Dueñas L, Pleitez-Navarrete J, Salgado DM, Castillo JB. Congenital and perinatal complications of chikungunya fever: a Latin American experience. Int J Infect Dis 2016; 51: 85-88
    CrossrefPubMedGoogle Scholar
  • 76 Petersen EE, Staples JE, Meaney-Delman D. , et al. Interim Guidelines for Pregnant Women During a Zika Virus Outbreak – United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 (02) 30-33
    CrossrefPubMedGoogle Scholar
  • 77 Ambros-Rudolph CM. Dermatoses of pregnancy - clues to diagnosis, fetal risk and therapy. Ann Dermatol 2011; 23 (03) 265-275
    CrossrefPubMedGoogle Scholar
  • 78 Teixeira MG, Costa MdaC, de Oliveira WK, Nunes ML, Rodrigues LC. The Epidemic of Zika Virus-Related Microcephaly in Brazil: Detection, Control, Etiology, and Future Scenarios. Am J Public Health 2016; 106 (04) 601-605
    CrossrefPubMedGoogle Scholar