DIAGNOSIS OF FETAL INFECTIONS - THE MODALITY
Dr. Sujatha Jagadeesh*, Dr. Lathaa Bhat**, Dr. V. Madhavi***, Dr. S. Suresh****, Dr. Indrani Suresh*****, Dr. S. Lata******, Dr. Kamakshi Kartik*******
Dept. of Genetic Counseling.*, Dept. of Genetic Counseling.**, Dept. of Genetic Counseling.***, Department of Ultrasound.****, Department of Ultrasound.*****, Department of Pathology Fetal Care Research Foundation, Chennai.******, Department of Pathology Fetal Care Research Foundation, Chennai.*******
Introduction
Fetal infection is a fairly common problem. It is a source of great anxiety to the expectant mother and the family. Most are innocuous causing no significant problem to the mother or fetus. However, some are teratogenic.
Aim
To identify the various presentations of confirmed cases of fetal CMV, Toxoplasmosis and Rubella infections in the last four-year period, from January 2001 - December 2005.
Subjects & Methods
Cases included in the study were all that were referred to our center for a) antenatal ultrasound, b) genetic counseling in view of abnormal ultrasound, c) fetal sampling and, d) autopsy after termination/intrauterine death/neonatal death.
Inclusion Criteria
All cases with abnormal ultrasound suggestive of fetal infections that were followed by confirmed diagnosis of fetal CMV, Toxoplasmosis and Rubella were selected. Abnormal fetal ultrasound include

Fetuses that were sent only for autopsy and had evidence of specific infections on the histopathological examination were included.
Study Protocol
Retrospective study, following fetal abnormalities on ultrasound, parents were counseled about the possible etiologies and the need for confirmation of diagnosis. Fetal sampling would be the only way to do it. He details of fetal procedure, the risks and cost involved are explained. Amniocentesis/fetal blood sampling were done. Fetal infections were confirmed if IgM antibodies were present against specific infections or PCR was positive in the fetal fluid and karyotype was normal
Results
In the 5 year period, number of abnormal scans suggestive of infections were 603. Fetal procedure done in 128. Infections on autopsy was observed in 2. CMV infections by fetal sampling and confirmed by autopsy was possible in 3. Mixed infections detected by PCR only CMV and Toxoplasmosis in 1. Rubella identified by PCR only in 1. Chromosomal anomalies detected in 16. Immune hydrops was noticed in 10. The findings on the rest of the cases will be given in a pie chart. The findings on scan, correlation with fetal tests and autopsy findings will be discussed.
Limitations
This is just a beginning that has been made over the years in our center. This project will at least be able to highlight the little progress that has been made in this fascinating field of fetal medicine, which is still in its embryonic stage in our country.
Conclusion
Fetal medicine is still in its infancy. The centers that specialize in the same are limited. The limitations are due to the difficulties in handling various aspects of fetal care like identifying and understanding the problems, suspecting a diagnosis, planning and performing fetal invasive procedures, deciphering the results of fetal investigations and guiding the affected parents through their ordeal. A lot of experience and expertise built on a strong foundation of knowledge of human embryology is required before one can venture on this process.
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Jagadeesh S D, Bhat L D, Madhavi V D, Suresh S D, Suresh I D, Lata S D, Kartik K D.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=368
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