Fetomaternal

1. Toxoplasmosis is harmful during pregnancy especially at first tri-
mester.1
Fetoplacental infection can occur immediately after mater-
nal infection, possibly even before development of the maternal se-
rologic response.2
Acute infection can unrecognized in 90% cases,
because subclinical and symptoms are nonspecific and suspect as a
viral infection.3
Most infants with congenital toxoplasmosis (80-90%) are asympto-
matic and no abnormalities at birth.4
Congenital toxoplasmosis in
this case suspected due to ultrasound finding of hydrocephalus and
periventricular calcification.
INTRODUCTION
Obstetrics and Gynecology Department
Faculty of Medicine, University of Indonesia
Harapan Kita Women and Children Hospital, Jakarta, Indonesia
Congenital Anomaly Baby with Suspected Congenital Toxoplasmosis Intrauterine
Liedapraja MS*, Hapsari K, Pramuktini S
CASE PRESENTATION
Mrs. A, 39 year old with multigravida, 29 weeks gestational age, singleton live head
presentation with hydrocephalus.
Patient referred to Harapan Kita Women and Children hospital due to hydrocephalus
Ultrasonography findings show severe bilateral ventriculomegaly (18 mm)
Dangle of the choroid plexus, hypoplasia of nasal bone and absent cavum septum
Her initial serologic test were IgG 110 IU/ml (normal range <4 IU/ml), IgM 0.460 IU/
(normal range < 0.55 IU/ml). After 3 weeks the test were repeated and measured.
The new laboratory result were IgG 65 IU/ml
Amniocentesis was conducted at 33 weeks of gestation.
Karyotyping results was normal and revealed 46, XX Female karyotyping
Pregnancy was waiting until term pregnancy for termination.
A Female neonate weighing 2380 gram was born at 40 weeks via caesarean section
No abnormalities in physical examination
ULTRASONOGRAPHY
Severe bilateral ventriculomegaly ( 18 mm)
and ‘Dangle” of the choroid plexus
Periventricular calcification
NEONATAL INVESTIGATION
Neonatal blood was collected for PCR toxoplasmosis and PCR CMV, PCR re-
sults for toxoplasmosis and CMV were negative
Head ultrasonography of baby revealed communication hydrocephalus, dilata-
tion of 3rd
and 4th
ventricle without intracerebral calcification, thinning of right
hemisphere cerebrii, suspected as an obstruction of aquaductus of sylvii
Dilatation of lateral ventricle Dilatation of right posterior horn
DISCUSSION
CONCLUSION
In this case, we suspected congenital toxoplasmosis due to abnormality in ultrasonog-
raphy consists of hydrocephalus, intracranial calcification.
However, the causes of hydrocephalus are multifactorial. Initial investigations such as
serologic test and karyotyping were performed to diagnose of congenital toxoplasmo-
sis. In the absence of positive findings of congenital toxoplasmosis, we must be con-
sider as hereditary or congenital syndromes. The most important is communicating to
parents can be challenging.
REFERENCES
1. Giannoulis C, Zournatzi B, Giomisi A, Diza E, Tzafettas I. Toxoplasmosis during pregnancy: a case report and review of the literature. Hippokratia 2008; 12(3): 139-43.
2. Singh S. Mother-to-child transmission and diagnosis of Toxoplasma gondii infection during pregnancy. Indian journal of medical microbiology 2003; 21(2): 69-76.
3. Avelino MM, Amaral WN, Rodrigues IM, et al. Congenital toxoplasmosis and prenatal care state programs. BMC infectious diseases 2014; 14: 33.
4. Macones GA, McNamara J, Wallenstein M, Squires K. Discussion: 'Congenital toxoplasmosis' by Berrebi et al. American journal of obstetrics and gynecology 2010; 203(6): e1-3.
5. Paquet C, Yudin MH, Society of O, Gynaecologists of C. Toxoplasmosis in pregnancy: prevention, screening, and treatment. Journal of obstetrics and gynaecology Canada :
JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2013; 35(1): 78-81.
Toxoplasmosis is usually self-limited but if infected in first trimester often results in
miscarriage, stillbirth or sequelae in the newborn.3
Most infants with congenital toxo-
plasmosis (80-90%) are asymptomatic and no abnormalities at birth. Classic triad con-
sists of chorioretinitis, hydrocephalus and intracranial calcifications.4
Serologic test
used to establish diagnosis of maternal infection. Adequate serological screening of
pregnant and prenatal diagnosis can be helpful in reducing the incidence of congeni-
tal toxoplasmosis by 60%.4
In this case, the baby was treated by pyrimethamine. Congenital toxoplasmosis can
prevent by giving information and routine serologic screening that would allow a timely
decision for antibiotic treatment and prenatal diagnosis.3, 5
Whether serological screen-
ing for toxoplasmosis in all pregnant women is still controversial