EP20.05: Discordant cytomegalovirus infection in a dichorionic twin pregnancy: a rare case of periconceptional infection
Bibliographic record
Abstract
This case presents a rare finding of discordant CMV infection in dichorionic twins caused by periconceptional maternal CMV infection. A healthy 35-year-old G5P3 presents for a routine anatomical scan for a dichorionic diamniotic twin pregnancy which identifies in fetus 1: severe intrauterine growth restriction (IUGR), oligohydramnios, microcephaly, mild ventriculomegaly, small fetal kidneys, echogenic bowel, and ascites. A fetal MRI identifies additional brain anomalies including periventricular echogenic foci, cerebellar hypoplasia, possible polymicrogyria and schizencephaly. Ultrasound and MRI showed no anomalies in the co-twin (fetus 2). Maternal CMV serology showed no seroconversion in pregnancy and CMV avidity testing was suggestive of a remote infection occurring 4–8 weeks prior to conception. Two live female infants were delivered via planned Caesarean delivery at 37 + 5 weeks. Postnatal urine and cord blood testing of the twins revealed an unexpected CMV infection in fetus 1. Imaging, cord blood immunoglobulin and urine CMV PCR for fetus 2 was negative. Transplacental transmission of CMV can occur following a primary or recurrent infection. Fetal transmission rates and effects on the fetus vary with gestational age at infection. This case illustrates preconception or periconceptional maternal CMV infection can also be associated with severe congenital anomalies and was further complicated by the discordant findings, with only one twin infected with CMV. When ultrasound and MRI findings are highly suggestive of fetal infection, in the setting of negative CMV serology for acute infection, periconceptional CMV infection must be considered and confirmed with invasive testing and serial imaging.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".