<scp>ISUOG</scp> Practice Guidelines: role of ultrasound in congenital infection

Abstract

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice, and high-quality teaching and research related to diagnostic imaging in women's healthcare. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach, from experts, for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. The ISUOG CSC documents are not intended to establish a legal standard of care, because interpretation of the evidence that underpins the Guidelines may be influenced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG ([e-mail]). Ultrasound examination is key in the diagnosis and management of congenital infection. In some cases, the initial finding of abnormal ultrasound features may trigger maternal serological testing for congenital infection; in others, either infection screening or the mother's symptomatology may lead to targeted ultrasound scans with the aim of detecting fetal sequelae. Once congenital infection is diagnosed, ultrasound can be used to help determine the fetal prognosis and to guide further investigation and management. In this Guideline we examine the role of ultrasound in the diagnosis and management of congenital infection, discussing the ultrasound signs and the prognostic value of ultrasound findings. We look in detail at six types of infection and their causative agents: cytomegalovirus (CMV), toxoplasma, parvovirus B19, rubella virus, varicella-zoster virus (VZV, which causes chickenpox) and Zika virus (ZIKV). For each, we discuss the ultrasound signs, timing of infection in relation to gestational age and diagnosis of maternal and fetal infection, and give a brief outline of appropriate management. This Guideline does not address prevention or routine screening for congenital infections, as this can differ between countries. Clinicians should follow local guidelines regarding whether to offer screening, gestational age at screening, method of screening, interpretation of the test and follow-up of those who are screen-positive or screen-negative. Despite the fact that case reports of intrauterine herpes simplex virus (HSV) infection have been published, this infection is not included herein, as the majority of neonatal HSV infections are acquired at birth as a consequence of direct fetal contact with the infected birth canal or through infection of the of HSV infection from to is been to in of cases, to The and of for and We a of for the to The of the and the This with a and The for and the Guidelines for guidelines and through the of and clinical practice and clinical The to the recommendations are and the evidence that of the of used in Guidelines are in of of evidence is not to evidence are as practice ultrasound signs of congenital infection. 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is that is The of diagnosis is fetal ultrasound is as that is be with imaging. the with in interpretation of this to of in in the of the should be when the with is when the should not be used to gestational age in in which has been to in is not a and has its in the of infection should the of as of fetal should be with signs of should be in a with in fetal The in are when are regarding the ultrasound the may fetal should be to the and of to test for by The of a with fetal and should be should not be for the of as fetal is not this and fetal is the of in the should be in ultrasound or with ultrasound scans and the of further causes of and should be considered and as should be individual and the of of should be when Clinicians should the of the prognosis for a follow-up imaging with the of is In congenital infections, as and which can the of a ultrasound a this may not be of in which have been in with a who a with should have from a and as follow-up at of age is This Guideline of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) by the and by the Clinical Standards of and and Clinical of of Obstetrics and of of for and of Gynecology and of and of Obstetrics and and of Clinical of The of and of Obstetrics and of and of and of and for of and Ultrasound of of Obstetrics and of of of Obstetrics and of Clinical and of of Obstetrics and of Obstetrics and This Guideline should be ISUOG Practice role of ultrasound in congenital infection. Ultrasound for parvovirus in with or to from for from Ultrasound in with fetal of abnormal ultrasound in by congenital cytomegalovirus used by to infected with cytomegalovirus of congenital infection and of clinical signs in of to gestational age at maternal of serological test for infection at clinical Ultrasound in infected by parvovirus and neonatal in with congenital Zika The is not for the or of any by the should be to the for the