Which imaging studies are indicated in the workup of Zika virus infection in pregnancy?

Updated: Jun 30, 2021
  • Author: Bhagyashri D Navalkele, MD, MBBS; Chief Editor: Michael Stuart Bronze, MD  more...
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Diagnosis of congenital Zika virus infection during pregnancy can be performed using prenatal ultrasound and amniocentesis. However, interpretation of these tests is unknown. CDC recommends perfom shared decision-making between patient and provider prior to pursuing prenatal screening testing. 

Ultrasound examination specifically for detection of abnormalities related to congenital Zika virus infection are unknown due to variable sensitivity, specificity, positive and negative predictive values. [34]  Per CDC, prenatal ultrasound findings associated with congenital Zika virus infection include intracranial calcifications at the gray-white matter junction, ventriculomegaly, abnormalities of the corpus callosum, microcephaly, and limb anomalies. Correlation of prenatal ultrasound findings suggestive of congenital Zika virus infection with maternal laboratory evidence of Zika virus or maternal exposure to Zika virus during pregnancy should be taken into consideration during interpretation and reporting. There are no recommended timings to conduct ultrasound. Abnormal prenatal ultrasound has been detected in second and third trimester of pregnancy based on limited case reports. Frequency of prenatal ultrasound should be performed based on clinical judegement, patient preference and risk for Zika. 

Detection of a fetal anomaly should be followed by amniocentesis for evaluation of intrauterine Zika virus infection. Zika virus RNA can be found transiently in amniotic fluid, thus absence of RNA via NAAT does not rule out congenital Zika virus infection. The sensitivity and specificity of amniocentesis for determination of congenital infection and prediction of fetal abnormality is unknown. [35]


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