18–22 September 2011, Los Angeles, CA, USA Oral poster abstracts Methods: We reviewed all cases of prenatally diagnosed VGAM managed in our referral center during a 10-year period. VGAM was categorized into isolated forms and forms associated with any other abnormality, based on fetal ultrasound and MRI findings. Poor outcomes comprised termination of pregnancy with confirmation of antenatal findings, perinatal death, and severe cardiac and/or neurological impairment in survivors. Results: 21 cases of prenatally diagnosed VGAM were managed in our center. Four cases were isolated (19%) and 17 (81%) were associated with other anomalies. There were 9 terminations (43.0%) and 6 neonatal deaths (28.5%). Six children (28.5%) were still alive at last follow-up. Among them, three were considered prenatally as isolated VGAM. They have good outcome at four, three and one years of follow up. The three other were considered prenatally as associated VGAM. One child has a severe developmental and mental retardation at the last follow-up (2 years of age). The two other children have moderate mental retardation as assessed by physical and neurological examination at last examination (six month and 18 months respectively). VGAM associated with other anomalies was strongly associated with a poor outcome as compared to isolated forms (P < 10-4). Conclusions: Fetuses with VGAM and any associated ultrasound or MRI abnormality have a poor outcome, while those with strictly isolated VGAM tend to have a normal outcome. OP14.09 Congenital CMV infection – a new approach to prenatal follow up L. Levitt 1 , D. V. Valsky 1 , N. Yanai 2 , D. Hochner-Celnikier 1 , D. Wolf 3 , S. Yagel 1 1 Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt. Scopus, Jerusalem, Israel; 2 Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Ein Karem, Jerusalem, Israel; 3 Clinical Microbiology & Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein Karem, Jerusalem, Israel Objectives: In an era of growing public and healthcare awareness of congenital cytomegalovirus (cCMV) infection, we evaluated the prenatal tools for diagnosis of fetal disease in suspected pregnancies. Methods: Amniotic fluid (AF) specimens obtained prospectively from women with suspected infection between 2003–2010 were tested by quantitative CMV real-time PCR. Positive cases were included in the study. Fetal ultrasound scans and fetal MRI were evaluated. Newborns underwent clinical evaluation, brain US, lab and hearing tests; children were followed up to three years with developmental evaluation. In terminations of pregnancy, histopathlogical examination of fetuses and placenta was done. Results: 862 AF specimens were collected. CMV was detected in 55 cases (6.4%), all but one obtained from women with primary maternal infection. Of these 18 delivered, 31 underwent TOP, and 6 cases were lost to follow up. Typical abnormal early US findings (hyperecogenic bowel, ventriculomegaly, intra uterine growth retardation etc) were detected in 9/55 cases. Fetal MRI was conducted in 7/55 cases, 5 showed findings such as ventriculomegaly and white matter injury. In 4/5 abnormal MRI, early US was normal. 5 of the women who continued the pregnancy underwent hyperimmuneglobulin course. Disease was observed (hearing impairment, hypotonia) in 2/18 cases; both received ganciclovir for 1 year. Disease state was difficult to determine in terminations owing to insufficient material for pathology analysis at early stages of pregnancy. Analysis of AF viral load revealed a large range of overlap in pregnancies with and without disease, and did not correlate significantly with US findings. Conclusions: The value of early prenatal US as a predicator for cCMV disease is limited. Repeat US and fetal MRI are often offered in continuing pregnancies. In some cases courses of IVIG are administered. The value of close follow-up with repeated sonographic testing in better detection of the late sequelae of cCMV is promising however additional data are necessary. OP14.10 Congenital CMV infection: prenatal predictors and outcome L. Levitt 1 , D. V. Valsky 1 , N. Yanai 2 , D. Hochner-Celnikier 1 , D. Wolf 3 , S. Yagel 1 1 Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt. Scopus, Jerusalem, Israel; 2 Obsterics and Gynecology, Hadassah-Hebrew University Medical Center, Ein Karem, Jerusalem, Israel; 3 Clinical Microbiology & Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein Karem, Jerusalem, Israel Objectives: We evaluated the predictive value of tools for diagnosis of fetal infection and disease in suspected congenital cytomegalovirus (cCMV) infection. Methods: Amniotic fluid (AF) was obtained prospectively from women with suspected infection between 2003–2007 and tested by quantitative CMV real-time PCR (RT-PCR). Initial and follow-up prenatal ultrasound scans were done. Results were correlated with fetal infection and disease outcome by histopathlogical examination of fetuses and placenta, or virological and developmental newborn monitoring. Results: 462 AF specimens were collected. Maternal infection was categorized as primary in 149/462 (∼32%) based on seroconversion or low avidity IgG. CMV was detected in AF of 28, all primary infec- tions. RT-PCR had specificity and sensitivity of 100%, and 94.7% for cCMV infection, respectively. 8/28 delivered and 20 terminated. All newborns were free of symptoms and remain asymptomatic in follow up. Among terminated fetuses, 8 showed evidence of cCMV disease (e.g. micronodular encephalitis, microglial nodules); 2 fetuses were free of disease signs; in 10 pathology was unable to determine CMV disease status. Analysis of AF viral load showed large overlap in pregnancies with and without disease, but median viral load val- ues were significantly higher in fetuses with disease (P = 0.006). The specificity and PPV of viral load threshold (≥ 105 copies/ml) were 40% and 57.1%, respectively. US findings of 28 CMV positive preg- nancies correlated significantly with outcome (P = 0.03). Abnormal early US findings typical of cCMV infection (e.g. hyperechogenic bowel, ventriculomegaly, IUGR) were detected in 5/28, all of which were terminated. Sensitivity of early US for fetal disease was 55%, NPV 69.2%. US scans until delivery in continuing pregnancies were normal. Conclusions: Quantitative RT-PCR is a reliable marker for cCMV infection. Low PPV and specificity of viral load threshold preclude reliable prenatal disease prediction. Value of early prenatal US in cCMV is limited; value of repeated sonography in detection of late sequelae is promising, pending further study. Ultrasound in Obstetrics & Gynecology 2011; 38 (Suppl. 1): 56–167 97