Suggested algorithm for cytomegalovirus surveillance in low-risk pregnancies

Cytomegalovirus (CMV) is the most common cause of intrauterine infection, occurring in 0.2-2.2% of all neonates. The rare but serious neonatal manifestations have prompted widespread discussions of the use of CMV surveillance during pregnancy. This study describes a decision-analysis algorithm for a surveillance protocol to detect the maximal number of primary CMV infections in low-risk pregnancies. The steps of the protocol adhere to the routine antenatal follow-up schedule. All calculations were based on the most stringent data in the literature as applied to a theoretical cohort of 100,000 pregnant women in the general population. By the time of delivery, the protocol failed to detect only four potentially ill neonates in the study group. These cases may be diagnosed and treated postnatally. Incorporation of the protocol in antenatal follow-up can reduce diagnostic confusion, assist clinicians in timing invasive procedures, and potentially spare patients unnecessary terminations of pregnancy.