Table 3.

Clinical Details of 10 Mother-Fetus or Mother-Neonate Dyads With Serial Ultrasonography, With Normal Followed by Abnormal Ultrasound Reports, With Congenital Zika Syndrome Abnormalities

SR_ID (Reference)	Maternal ZIKV Infection, Weeks of Gestation	Last Normal Ultrasound Examination	First Abnormal Ultrasound Examination	Prenatal Ultrasound Examination Congenital Zika Syndrome Findings, Includes Abnormalities From All Examinations	Pregnancy Outcome	Fetal or Neonatal ZIKV Laboratory Test Results	Neonatal or Fetal Congenital Zika Syndrome Imaging and Clinical or Autopsy Examination Abnormalities
		[wk of Gestation (wk Elapsed from Maternal Symptoms)]
9 Benjamin et al17	Symptomatic at 10 wk; ZIKV NAT-positive maternal plasma at time of symptoms	14 (4)	19 (9)	Microcephaly, cerebellar abnormalities (hypoplasia); ventriculomegaly	Termination at 24 wk	ZIKV NAT-positive cord blood	Autopsy: hypoplasia of the corpus callosum, meningoencephalitis, calcifications, dilated ventricles; high sloping forehead, flat philtrum, nuchal and sub mental edema, microcephaly
38 Brasil et al18	Symptomatic at 8 wk; ZIKV NAT-positive in maternal blood, urine, or both UNK timing	17 (9)	20 (12)	Cerebellar atrophy (small transverse diameter)	Live birth at 39 wk	UNK	US and CT: periventricular lesions, global cerebral atrophy, macular lesions, congenital dislocation of hip
107 Driggers et al19	Symptomatic at 12 wk; ZIKV NAT-positive maternal serum 4 and 9 wk after symptoms	17 (5)	19 (7)	Cerebral atrophy (cerebral mantle appeared to be thin); corpus callosum abnormalities (agenesis); ventriculomegaly	Termination at 21 wk	ZIKV NAT-positive fetal tissues and placenta, membranes, and umbilical cord	Autopsy: normal anatomy, cortical atrophy, corpus callosum not well visualized, no overt microscopic abnormalities of the eyes
126 Mlakar et al20	Symptomatic at 13 wk; no maternal testing reported	20 (7)	29 (16)	Microcephaly, intracranial calcifications; cerebellar abnormalities; ventriculomegaly	Termination at 32 wk	ZIKV NAT-positive fetal brain tissue; ZIKV NAT-negative placenta and other fetal tissues	Autopsy: micrencephaly, widely open sylvian fissures, small cerebellum and brain stem, almost complete agyria and internal hydrocephalus of the lateral ventricles, numerous variable-sized calcifications in the cortex and subcortical white matter in the frontal, parietal, and occipital lobes
127 Moron et al21	Symptomatic at 13 wk; ZIKV NAT-negative maternal serum 16 wk after symptoms	22 (9)	29 (16)	Microcephaly, intracranial calcifications; cerebral atrophy; abnormal cortical formation (lissencephaly, pachygyria); ventriculomegaly	Live birth at 39 wk	ZIKV IgM negative serum, ZIKV IgG positive serum	CT: overlapping cranial bones and preserved cranial sutures, gross calcifications in cortical and subcortical structures with cerebral atrophy, ventriculomegaly and enlarged subarachnoid space; T2-weighted MRI: cranial-facial disproportion (microcephaly), cortical and subcortical atrophy, lissencephaly, pachygyria, increased subarachnoid space, nonhypertensive ventriculomegaly. Axial swan-weighted MRI: gross cortical and subcortical calcifications and signs of corpus callosum hypoplasia; clinical microcephaly
191 Perez et al22	Symptomatic at 8 wk; ZIKV NAT-positive maternal serum 9 wk after symptoms	12 (4)	19 (11)	Ventriculomegaly with hydrocephalus, arthrogryposis	Termination at 21 wk	ZIKV NAT-positive umbilical cord and brain tissue; ZIKV NAT-negative placenta	Autopsy: fetal hydrocephalus with dilation of both lateral ventricles, multiple calcifications at cortical level and brainstem; flexion contracture and deformity of joints of all four limbs, extreme flexion of hips and crossed femurs, under-developed muscles with replacement of muscle by adipose tissue
248 Suy et al23	Symptomatic at 9 wk; ZIKV NAT-positive maternal serum UNK timing	15 (6)	20 (11)	Intracranial calcifications (brain parenchyma); cerebral atrophy (severe); corpus callosum abnormalities (shortened); ventriculomegaly (bilateral, mild)	Live birth at 37 wk	ZIKV NAT-negative in CSF, urine, serum, placenta, membranes, and umbilical cord	US and MRI: intracranial calcifications, cerebral atrophy, thinned corpus callosum, microcephaly
250 Vesnaver24	Symptomatic at 13 wk; no maternal ZIKV testing	20 (7)	29 (16)	Microcephaly, intracranial calcifications; cerebellar abnormalities (small cerebellum); ventriculomegaly	Termination at 32 wk or more	ZIKV NAT-positive fetal brain tissue, ZIKV NAT-negative placenta, other organs	Autopsy: almost complete agyria with very few gyri in the occipital lobes resembling pachygyria, irregular white calcifications at the cortical-white matter border in the frontal and parietal lobes, lateral ventricles dilated; clinical microcephaly
252 Werner et al25	Symptomatic at 12 wk; no maternal ZIKV testing	21 (9)	32 (20)	Intracranial calcifications, microcephaly	Live birth at 38 wk	UNK	US: subcortical and periventricular calcifications with ventricular dilatation; clinical microcephaly; CTat 10 d: microcephaly, cortical atrophy, brain calcifications and small anterior fontanel with premature closure of metopic and coronal sutures; MRI at 1 mo: cephalic circumference 32.0 cm, pachygyria, corpus callosal dysgenesis, subcortical frontoparietal brain calcifications
253 Werner et al26	Symptomatic at 10 wk; ZIKV serology 23 wk after symptoms	29 (19)	33 (23)	Microcephaly, intracranial calcifications (periventricular); abnormal cortical formation (lissencephaly); ventriculomegaly	Live birth at 37 wk	ZIKV NAT-positive urine, blood; ZIKV NAT-negative CSF	US: thinning of the frontoparietal parenchyma, calcifications on the frontal brain surfaces and corpus callosum dysgenesis; persistent loud crying, seizures of upper and lower left limbs; CT at 30 d: borderline ventriculomegaly, corpus callosum dysgenesis, parenchymal atrophy, widespread multiple brain calcifications, small anterior fontanel with overlapping metopic and coronal sutures; MRI at 1 mo: HC measuring 30.0 cm, tapered frontoparietal parenchyma, pachygyria, underdeveloped sulci and gyri, extensive calcifications particularly in subcortical areas, and dysgenesis of the corpus callosum, multiple subcortical frontoparietal calcifications
356 Sulleiro et al27	Symptomatic at 9 wk; ZIKV NAT-positive maternal serum 3 wk after symptoms	15 (6)	19 (10)	Bilateral ventriculomegaly	Live birth at 37 wk	ZIKV NAT- and IgM-negative neonatal serum	US, CT, and MRI: microcephaly with a thinned corpus callosum and brain atrophy with parenchymal calcifications. Clinical: severe microcephaly, craniofacial disproportion, partially collapsed skull, prominent occiput, and excess nuchal skin. Neurologic examination: irritability, hyperexcitability, exacerbation of the primitive reflexes, inconsolable crying, and joint contractures.
357 Valdespino-Vazquez et al28	Symptomatic at 14 wk; ZIKV NAT-negative maternal serum 14 wk after symptoms; ZIKV NAT-positive fetal tissue at autopsy	24 (10)	28 (14)	Microcephaly, enlarged lateral ventricles, oligohydramnios, cortical calcifications	Live birth at 30 wk; neonatal death at 4 h	ZIKV NAT-positive fetal tissue	Autopsy: microcephaly, micrognathia and retrognathia, low-set ears, depressed nasal bridge, arthrogryposis; hypoplastic cerebral lobes and brain stem, lissencephaly, ventriculomegaly, cerebral calcifications.

SR_ID, systematic review identification number; ZIKV, Zika virus; NAT, nucleic acid test; UNK, unknown, US, ultrasonography; CT, computed tomography; IgM, immunoglobulin M; IgG, immunoglobulin G; MRI, magnetic resonance imageing; CSF, cerebrospinal fluid;