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    Zika on the ground: Clinical impact update

    Two new reports—one by the Centers for Disease Control and Prevention (CDC) and another a case report of a third-trimester fetal demise—are helping to bring into increased focus the potential clinical impact of Zika virus. Published in MMWR, the CDC data provide perspective on testing for the virus in pregnant women who have traveled to endemic areas. The case report, published in PLOS Neglected Tropical Diseases, suggests a linkage between Zika and hydrops fetal and fetal demise.

    More: Pregnant women and Zika exposure

    The MMWR report is an analysis of requests to CDC for testing for Zika virus by pregnant women between August 1, 2015 and February 10, 2016. Of the 257 pregnant women who made such requests during that period, 151 (59%) had two or more signs or symptoms consistent with Zika (i.e. acute onset of fever, rash, conjunctivitis, or arthralgia.). None of the women had Zika-related hospitalizations or deaths.

    Two of the pregnancies resulted in early loss and 2 were electively terminated. As of the report, 2 pregnancies, at 18 and 34 weeks’ respectively, were continuing with no known complications. Of the 3 babies born alive to the women tested, 2 are apparently normal and 1 has severe microcephaly. Both of the healthy infants are the offspring of women who had symptoms of Zika virus infection during pregnancy, one in the second trimester and the other in the third trimester. Overall, 7 pregnant women with confirmed Zika virus infections reported fever during pregnancy. Whether that affected their pregnancy outcomes is unknown.

    The report in PLOS Neglected Tropical Diseases concerns a 20-year-old pregnant woman from Salvador, Brazil who had no symptoms of Zika virus but whose 18-week ultrasound showed intrauterine growth restriction. Subsequent second- and third-trimester ultrasounds showed severe microcephaly, hydranencephaly, intracranial calcifications, and destructive lesions of the posterior fossa as well as hydrothorax, ascites, and subcutaneous edema. At 32 weeks, labor was induced due to fetal demise. Polymerase chain reaction testing for Zika virus was positive in extracts from the cerebral cortex, medulla oblongata and cerebrospinal and amniotic fluid.

    The authors of the case report believe that it may indicate a link between Zika virus infection and hydrops fetalis and fetal demise as well as microcephaly, but the results cannot be extrapolated to come to conclusions about the overall risk. They theorize that the mother may have been exposed to Zika virus during the first trimester, resulting in an intrauterine infection that led to the fetal hydranencephaly and hydrops fetalis.

    The CDC is establishing a new registry for US pregnant women with confirmed Zika virus infection and their infants. Health care providers are encouraged to discuss participation in the registry with pregnant patients who have the infection and can contact Dana Meaney-Delman at [email protected] or 770-488-7100 with questions about it.

    NEXT: Does vaginal delivery increase risk of incontinence?

    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.
    Miranda Hester
    Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.


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