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Refining the prognosis of fetuses infected with Cytomegalovirus in the first trimester of pregnancy by serial prenatal assessment: a single‐centre retrospective study
Objective To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection
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| Published in: | BJOG : an international journal of obstetrics and gynaecology 2020-02, Vol.127 (3), p.355-362 |
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| container_issue | 3 |
| container_start_page | 355 |
| container_title | BJOG : an international journal of obstetrics and gynaecology |
| container_volume | 127 |
| creator | Faure‐Bardon, V Millischer, A‐E Deloison, B Sonigo, P Grévent, D Salomon, L Stirnemann, J Nicloux, M Magny, J‐F Leruez‐Ville, M Ville, Y |
| description | Objective
To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection |
| doi_str_mv | 10.1111/1471-0528.15935 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2288752047</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2338878032</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3715-33842d5c57dcd355904655eb11c4a57fd7f535b0dfa406baa801aa78d84c0ac03</originalsourceid><addsrcrecordid>eNqFkc9u1DAQxi1ERUvhzA1Z4sIlrR3HG5cbrPjTqlIlBGfLscdbV4mzeJxWufEIPAbPxZPg7LY9cMEXj8a_-TwzHyGvODvh5ZzypuUVk7U64fJMyCfk6DHzdBeziolaHZLniDeM8VXNxDNyKLhkkjNxRH5_BR9iiBuar4Fu07iJIwako6ce8oSANEQPNoOjdyFf0_WcxwE2ph9vQ5qW112lDwkzzSkMgBnSUr9NsIkm2pl2M0VIwfRLLppcAoNFGgeI-R01FEsDPfz5-cuWRAKaIKcRt-XbcAsU8-TmF-TAmx7h5f19TL5_-vht_aW6vPp8vn5_WVnRclkJoZraSStbZ52Q8ow1Kymh49w2RrbetV4K2THnTcNWnTGKcWNa5VRjmbFMHJO3e92yix9TGUYPAS30vYkwTqjrWqlW1qxpC_rmH_RmnFIs3em69KFaVXZfqNM9ZctImMDrbdmSSbPmTC8m6sUyvVimdyaWitf3ulM3gHvkH1wrgNwDd6GH-X96-sPF1V74L1zkqxs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2338878032</pqid></control><display><type>article</type><title>Refining the prognosis of fetuses infected with Cytomegalovirus in the first trimester of pregnancy by serial prenatal assessment: a single‐centre retrospective study</title><source>Wiley</source><creator>Faure‐Bardon, V ; Millischer, A‐E ; Deloison, B ; Sonigo, P ; Grévent, D ; Salomon, L ; Stirnemann, J ; Nicloux, M ; Magny, J‐F ; Leruez‐Ville, M ; Ville, Y</creator><creatorcontrib>Faure‐Bardon, V ; Millischer, A‐E ; Deloison, B ; Sonigo, P ; Grévent, D ; Salomon, L ; Stirnemann, J ; Nicloux, M ; Magny, J‐F ; Leruez‐Ville, M ; Ville, Y</creatorcontrib><description>Objective
To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection <14 weeks of gestation, at different time points of pregnancy: the end of the second trimester; following prenatal magnetic resonance imaging (MRI) at 32 weeks of gestation; and using all ultrasound scans performed in the third trimester (US3rdT).
Design
A retrospective study.
Setting
Reference fetal medicine unit.
Population
Sixty‐two fetuses infected <14 weeks of gestation.
Methods
We defined second‐trimester assessment (STA) as the combination of ultrasound findings <28 weeks of gestation and fetal platelet count at cordocentesis. Three groups were defined: normal, extracerebral, and cerebral STA.
Main outcome measures
For each group, the PV of STA alone, STA + MRI, and STA + US3rdT were assessed retrospectively. Outcome at birth and at follow‐up were reported.
Results
The STA was normal, and with extracerebral and cerebral features, in 43.5, 42.0, and 14.5%, respectively. The negative PV of normal STA and MRI for moderate to severe sequelae was 100%. The residual risk was unilateral hearing loss in 16.7% of cases. Of pregnancies with cerebral STA, 44% were terminated. Following extracerebral STA, 48% of neonates were symptomatic and 30% had moderate to severe sequelae. In those cases, the positive and negative PV of MRI for sequelae were 33 and 73%, respectively. STA + US3rdT had a lower negative PV than MRI for symptoms at birth and for moderate to severe sequelae. Any false‐positive findings at MRI were mostly the result of hypersignals of white matter.
Conclusions
Serial assessment in the second and third trimesters by ultrasound and MRI is necessary to predict the risk of sequelae occurring in 35% of pregnancies following fetal infection in the first trimester of pregnancy.
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Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.
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Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.</description><identifier>ISSN: 1470-0328</identifier><identifier>EISSN: 1471-0528</identifier><identifier>DOI: 10.1111/1471-0528.15935</identifier><identifier>PMID: 31505103</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Abortion, Eugenic - statistics & numerical data ; Adult ; Autopsy ; Birth ; Brain - diagnostic imaging ; Complications ; Congenital Cytomegalovirus infection ; cordocentesis ; Cytomegalovirus ; Cytomegalovirus - isolation & purification ; Cytomegalovirus Infections - diagnosis ; Cytomegalovirus Infections - epidemiology ; Female ; Fetal Diseases - etiology ; Fetal Diseases - pathology ; Fetuses ; France ; Gestation ; Health risk assessment ; Hearing loss ; Humans ; Infant ; Infant, Newborn ; Infections ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Male ; Medical prognosis ; Neonates ; Polymicrogyria - etiology ; Polymicrogyria - pathology ; Predictive Value of Tests ; Pregnancy ; Pregnancy Complications, Infectious - diagnosis ; Pregnancy Complications, Infectious - epidemiology ; Pregnancy Trimesters ; Prognosis ; prognostic ; Substantia alba ; Ultrasonic imaging ; Ultrasonography, Prenatal - methods ; Ultrasound</subject><ispartof>BJOG : an international journal of obstetrics and gynaecology, 2020-02, Vol.127 (3), p.355-362</ispartof><rights>2019 Royal College of Obstetricians and Gynaecologists</rights><rights>2019 Royal College of Obstetricians and Gynaecologists.</rights><rights>Copyright © 2020 Royal College of Obstetricians and Gynaecologists</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3715-33842d5c57dcd355904655eb11c4a57fd7f535b0dfa406baa801aa78d84c0ac03</citedby><cites>FETCH-LOGICAL-c3715-33842d5c57dcd355904655eb11c4a57fd7f535b0dfa406baa801aa78d84c0ac03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2F1471-0528.15935$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2F1471-0528.15935$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31505103$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Faure‐Bardon, V</creatorcontrib><creatorcontrib>Millischer, A‐E</creatorcontrib><creatorcontrib>Deloison, B</creatorcontrib><creatorcontrib>Sonigo, P</creatorcontrib><creatorcontrib>Grévent, D</creatorcontrib><creatorcontrib>Salomon, L</creatorcontrib><creatorcontrib>Stirnemann, J</creatorcontrib><creatorcontrib>Nicloux, M</creatorcontrib><creatorcontrib>Magny, J‐F</creatorcontrib><creatorcontrib>Leruez‐Ville, M</creatorcontrib><creatorcontrib>Ville, Y</creatorcontrib><title>Refining the prognosis of fetuses infected with Cytomegalovirus in the first trimester of pregnancy by serial prenatal assessment: a single‐centre retrospective study</title><title>BJOG : an international journal of obstetrics and gynaecology</title><addtitle>BJOG</addtitle><description>Objective
To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection <14 weeks of gestation, at different time points of pregnancy: the end of the second trimester; following prenatal magnetic resonance imaging (MRI) at 32 weeks of gestation; and using all ultrasound scans performed in the third trimester (US3rdT).
Design
A retrospective study.
Setting
Reference fetal medicine unit.
Population
Sixty‐two fetuses infected <14 weeks of gestation.
Methods
We defined second‐trimester assessment (STA) as the combination of ultrasound findings <28 weeks of gestation and fetal platelet count at cordocentesis. Three groups were defined: normal, extracerebral, and cerebral STA.
Main outcome measures
For each group, the PV of STA alone, STA + MRI, and STA + US3rdT were assessed retrospectively. Outcome at birth and at follow‐up were reported.
Results
The STA was normal, and with extracerebral and cerebral features, in 43.5, 42.0, and 14.5%, respectively. The negative PV of normal STA and MRI for moderate to severe sequelae was 100%. The residual risk was unilateral hearing loss in 16.7% of cases. Of pregnancies with cerebral STA, 44% were terminated. Following extracerebral STA, 48% of neonates were symptomatic and 30% had moderate to severe sequelae. In those cases, the positive and negative PV of MRI for sequelae were 33 and 73%, respectively. STA + US3rdT had a lower negative PV than MRI for symptoms at birth and for moderate to severe sequelae. Any false‐positive findings at MRI were mostly the result of hypersignals of white matter.
Conclusions
Serial assessment in the second and third trimesters by ultrasound and MRI is necessary to predict the risk of sequelae occurring in 35% of pregnancies following fetal infection in the first trimester of pregnancy.
Tweetable
Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.
Tweetable
Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.</description><subject>Abortion, Eugenic - statistics & numerical data</subject><subject>Adult</subject><subject>Autopsy</subject><subject>Birth</subject><subject>Brain - diagnostic imaging</subject><subject>Complications</subject><subject>Congenital Cytomegalovirus infection</subject><subject>cordocentesis</subject><subject>Cytomegalovirus</subject><subject>Cytomegalovirus - isolation & purification</subject><subject>Cytomegalovirus Infections - diagnosis</subject><subject>Cytomegalovirus Infections - epidemiology</subject><subject>Female</subject><subject>Fetal Diseases - etiology</subject><subject>Fetal Diseases - pathology</subject><subject>Fetuses</subject><subject>France</subject><subject>Gestation</subject><subject>Health risk assessment</subject><subject>Hearing loss</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infections</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Neonates</subject><subject>Polymicrogyria - etiology</subject><subject>Polymicrogyria - pathology</subject><subject>Predictive Value of Tests</subject><subject>Pregnancy</subject><subject>Pregnancy Complications, Infectious - diagnosis</subject><subject>Pregnancy Complications, Infectious - epidemiology</subject><subject>Pregnancy Trimesters</subject><subject>Prognosis</subject><subject>prognostic</subject><subject>Substantia alba</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography, Prenatal - methods</subject><subject>Ultrasound</subject><issn>1470-0328</issn><issn>1471-0528</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqFkc9u1DAQxi1ERUvhzA1Z4sIlrR3HG5cbrPjTqlIlBGfLscdbV4mzeJxWufEIPAbPxZPg7LY9cMEXj8a_-TwzHyGvODvh5ZzypuUVk7U64fJMyCfk6DHzdBeziolaHZLniDeM8VXNxDNyKLhkkjNxRH5_BR9iiBuar4Fu07iJIwako6ce8oSANEQPNoOjdyFf0_WcxwE2ph9vQ5qW112lDwkzzSkMgBnSUr9NsIkm2pl2M0VIwfRLLppcAoNFGgeI-R01FEsDPfz5-cuWRAKaIKcRt-XbcAsU8-TmF-TAmx7h5f19TL5_-vht_aW6vPp8vn5_WVnRclkJoZraSStbZ52Q8ow1Kymh49w2RrbetV4K2THnTcNWnTGKcWNa5VRjmbFMHJO3e92yix9TGUYPAS30vYkwTqjrWqlW1qxpC_rmH_RmnFIs3em69KFaVXZfqNM9ZctImMDrbdmSSbPmTC8m6sUyvVimdyaWitf3ulM3gHvkH1wrgNwDd6GH-X96-sPF1V74L1zkqxs</recordid><startdate>202002</startdate><enddate>202002</enddate><creator>Faure‐Bardon, V</creator><creator>Millischer, A‐E</creator><creator>Deloison, B</creator><creator>Sonigo, P</creator><creator>Grévent, D</creator><creator>Salomon, L</creator><creator>Stirnemann, J</creator><creator>Nicloux, M</creator><creator>Magny, J‐F</creator><creator>Leruez‐Ville, M</creator><creator>Ville, Y</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>202002</creationdate><title>Refining the prognosis of fetuses infected with Cytomegalovirus in the first trimester of pregnancy by serial prenatal assessment: a single‐centre retrospective study</title><author>Faure‐Bardon, V ; Millischer, A‐E ; Deloison, B ; Sonigo, P ; Grévent, D ; Salomon, L ; Stirnemann, J ; Nicloux, M ; Magny, J‐F ; Leruez‐Ville, M ; Ville, Y</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3715-33842d5c57dcd355904655eb11c4a57fd7f535b0dfa406baa801aa78d84c0ac03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abortion, Eugenic - statistics & numerical data</topic><topic>Adult</topic><topic>Autopsy</topic><topic>Birth</topic><topic>Brain - diagnostic imaging</topic><topic>Complications</topic><topic>Congenital Cytomegalovirus infection</topic><topic>cordocentesis</topic><topic>Cytomegalovirus</topic><topic>Cytomegalovirus - isolation & purification</topic><topic>Cytomegalovirus Infections - diagnosis</topic><topic>Cytomegalovirus Infections - epidemiology</topic><topic>Female</topic><topic>Fetal Diseases - etiology</topic><topic>Fetal Diseases - pathology</topic><topic>Fetuses</topic><topic>France</topic><topic>Gestation</topic><topic>Health risk assessment</topic><topic>Hearing loss</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infections</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Neonates</topic><topic>Polymicrogyria - etiology</topic><topic>Polymicrogyria - pathology</topic><topic>Predictive Value of Tests</topic><topic>Pregnancy</topic><topic>Pregnancy Complications, Infectious - diagnosis</topic><topic>Pregnancy Complications, Infectious - epidemiology</topic><topic>Pregnancy Trimesters</topic><topic>Prognosis</topic><topic>prognostic</topic><topic>Substantia alba</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography, Prenatal - methods</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Faure‐Bardon, V</creatorcontrib><creatorcontrib>Millischer, A‐E</creatorcontrib><creatorcontrib>Deloison, B</creatorcontrib><creatorcontrib>Sonigo, P</creatorcontrib><creatorcontrib>Grévent, D</creatorcontrib><creatorcontrib>Salomon, L</creatorcontrib><creatorcontrib>Stirnemann, J</creatorcontrib><creatorcontrib>Nicloux, M</creatorcontrib><creatorcontrib>Magny, J‐F</creatorcontrib><creatorcontrib>Leruez‐Ville, M</creatorcontrib><creatorcontrib>Ville, Y</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Faure‐Bardon, V</au><au>Millischer, A‐E</au><au>Deloison, B</au><au>Sonigo, P</au><au>Grévent, D</au><au>Salomon, L</au><au>Stirnemann, J</au><au>Nicloux, M</au><au>Magny, J‐F</au><au>Leruez‐Ville, M</au><au>Ville, Y</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Refining the prognosis of fetuses infected with Cytomegalovirus in the first trimester of pregnancy by serial prenatal assessment: a single‐centre retrospective study</atitle><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle><addtitle>BJOG</addtitle><date>2020-02</date><risdate>2020</risdate><volume>127</volume><issue>3</issue><spage>355</spage><epage>362</epage><pages>355-362</pages><issn>1470-0328</issn><eissn>1471-0528</eissn><notes>This article is commented on by DA Muin, p. 363 in this issue. To view this mini commentary visit</notes><notes>Linked article</notes><notes>https://doi.org/10.1111/1471-0528.16006</notes><notes>.</notes><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Objective
To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection <14 weeks of gestation, at different time points of pregnancy: the end of the second trimester; following prenatal magnetic resonance imaging (MRI) at 32 weeks of gestation; and using all ultrasound scans performed in the third trimester (US3rdT).
Design
A retrospective study.
Setting
Reference fetal medicine unit.
Population
Sixty‐two fetuses infected <14 weeks of gestation.
Methods
We defined second‐trimester assessment (STA) as the combination of ultrasound findings <28 weeks of gestation and fetal platelet count at cordocentesis. Three groups were defined: normal, extracerebral, and cerebral STA.
Main outcome measures
For each group, the PV of STA alone, STA + MRI, and STA + US3rdT were assessed retrospectively. Outcome at birth and at follow‐up were reported.
Results
The STA was normal, and with extracerebral and cerebral features, in 43.5, 42.0, and 14.5%, respectively. The negative PV of normal STA and MRI for moderate to severe sequelae was 100%. The residual risk was unilateral hearing loss in 16.7% of cases. Of pregnancies with cerebral STA, 44% were terminated. Following extracerebral STA, 48% of neonates were symptomatic and 30% had moderate to severe sequelae. In those cases, the positive and negative PV of MRI for sequelae were 33 and 73%, respectively. STA + US3rdT had a lower negative PV than MRI for symptoms at birth and for moderate to severe sequelae. Any false‐positive findings at MRI were mostly the result of hypersignals of white matter.
Conclusions
Serial assessment in the second and third trimesters by ultrasound and MRI is necessary to predict the risk of sequelae occurring in 35% of pregnancies following fetal infection in the first trimester of pregnancy.
Tweetable
Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.
Tweetable
Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31505103</pmid><doi>10.1111/1471-0528.15935</doi><tpages>8</tpages></addata></record> |
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| ispartof | BJOG : an international journal of obstetrics and gynaecology, 2020-02, Vol.127 (3), p.355-362 |
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| language | eng |
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| source | Wiley |
| subjects | Abortion, Eugenic - statistics & numerical data Adult Autopsy Birth Brain - diagnostic imaging Complications Congenital Cytomegalovirus infection cordocentesis Cytomegalovirus Cytomegalovirus - isolation & purification Cytomegalovirus Infections - diagnosis Cytomegalovirus Infections - epidemiology Female Fetal Diseases - etiology Fetal Diseases - pathology Fetuses France Gestation Health risk assessment Hearing loss Humans Infant Infant, Newborn Infections Magnetic resonance imaging Magnetic Resonance Imaging - methods Male Medical prognosis Neonates Polymicrogyria - etiology Polymicrogyria - pathology Predictive Value of Tests Pregnancy Pregnancy Complications, Infectious - diagnosis Pregnancy Complications, Infectious - epidemiology Pregnancy Trimesters Prognosis prognostic Substantia alba Ultrasonic imaging Ultrasonography, Prenatal - methods Ultrasound |
| title | Refining the prognosis of fetuses infected with Cytomegalovirus in the first trimester of pregnancy by serial prenatal assessment: a single‐centre retrospective study |
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