Author of the article - an obstetrician Grigorieva Xenia S.
Cytomegalovirus (CMV) infection - infectious disease, whose symptoms are manifested only when immunodeficiency states (with the weakening of immunity). The risk of fetal infection, disease severity and prognosis depend on the activity of life processes cytomegalovirus during pregnancy.
Cytomegalovirus infection is diagnosed by detection of specific antibodies in the blood. Early detection of the disease is complicated by the fact that in 90% of cases it manifests itself in any way.
Causes
Cytomegalovirus refers to the family of herpes viruses. There are several ways of infection:
- airborne (by sneezing, coughing, kiss);
- hematogenous (blood-borne);
- sexual (unprotected intercourse);
- transplacental (mother to the fetus through the placenta);
- through breast milk;
- vertical (during labor).
Several distinct forms of CMV infection:
- primary;
- primary chronic;
- congenital;
- latent (hidden, inactive);
- reactivate the persistent (chronic activation of the shape);
- superinfection (accession other infection).
If infection has occurred, the virus is found in all body fluids (blood, urine, saliva, breast milk, from the genital tract, tears).
Symptoms of CMV during pregnancy
In most cases, the symptoms of CMV infection are absent or insignificant. There may be signs of flu or mononucleosis-like syndrome (fever, chills, weakness, pain in muscles and joints).
Important! It is also a symptom is intermittent and irregular fever for a month or more, accompanied by nausea and drowsiness.
Diagnostics
The most effective methods of diagnosis:
determination of serum antibody titer to CMV infection (serological method).
- Primary infection during pregnancy is a more unfavorable course than the chronic form.
- After suffering an infection in a woman's blood is stored specific IgGThat protect the fetus from infection later. IgM-antibodies indicate primary infection, increase in IgG - the activation of the chronic form.
PCR method.
- Allows detection of cytomegalovirus DNA in biological fluids (blood, saliva, secretion from the genital tract, urine). But this method does not indicate the nature of the infection (primary or chronic).
Diagnosis of fetal infection is performed using analysis of amniotic fluid (amniocentesis) At 11-19 and 22-23 weeks of gestation. US in this case, enough sensitive method for detecting abnormalities in a fetus.
Important! Given the fact that the infection often has no symptoms, all pregnant women to carry out screening for CMV antibodies.
In infants detect the presence of the virus in urine or secretions from the throat at 1-2 weeks of age. But 35% of IgM antibodies (responsible for primary infection) may be absent.
differential diagnosis
CMV infection in pregnant women need to be differentiated from acute respiratory infections, pneumonia, infectious mononucleosis, toxoplasmosis, Hepatitis. Accurate diagnosis is based on laboratory tests.
Treatment of CMV infection on trimesters
Treatment of cytomegalovirus during pregnancy has been a gynecologist or infectious diseases. With the development of complications requiring hospitalization pregnant.
Treatment should be aimed at the prevention of intrauterine infection and prevention of congenital infection in the newborn.
To eliminate symptoms, antiviral therapy is carried out, but due to the high toxicity of these drugs are prohibited during pregnancy, permitted only in severe cases.
As the non-drug treatment is applied plasmapheresis, intravenous injection of the specific immunoglobulin or immunostimulants (to maintain immunity and reduce the spread of infection).
Regimen 1 trimester:
- Immunotherapy: intravenous immunoglobulin Tsitotekta;
- Acyclovir intravenously only in severe;
- 4 weeks control PCR analysis (scraping from the cervix).
The treatment regimen of 2 trimester:
- Immunotherapy: intravenous immunoglobulin, Tsitotekta, rectal suppositories Viferon;
- Acyclovir intravenously only in severe;
- 4 weeks control PCR analysis (scraping from the cervix).
Regimen 3 trimester:
- antiviral therapy (acyclovir);
- Immunotherapy: intravenous immunoglobulin, Tsitotekta, rectal suppositories Viferon;
- 4 weeks control PCR analysis (scraping from the cervix).
In identifying severe malformations in the fetus the woman may be offered medical abortion at her request.
delivery
Childbirth through natural ways is not contraindicated during CMV infection, the hospital conducted an observational unit. The delivery processing is carried out with a solution of the birth canal Poludan (antiviral drug). Caesarean section is performed only for obstetric indications.
possible complications
Congenital infection is diagnosed in 2% of cases. Thus 80-90% of infected women are born healthy children with the condition of the complex treatment and supervision by a doctor.
Congenital cytomegalovirus infection in newborn infants
In order to confirm the diagnosis of congenital CMV infection, it is necessary to examine the blood from the umbilical cord for the presence of IgM and IgG titers of antibodies. Also determine their presence in the urine and saliva of the newborn in the first 3 weeks of life, then once a month.
The incidence of congenital CMV infection does not exceed 2-2.5% in the chronic form of the mother, 40% - during the primary infection during gestation baby.
Infection with CMV infection in the first trimester of pregnancy more dangerous. If the birth of a child are no signs of the disease, the risk of serious complications is less than 10%. Possible complications:
- microcephaly (reduce skull and brain);
- hydrocephalus (Fluid accumulation in the brain);
- calcification (cluster salts) in the brain;
- chorioretinitis (inflammation of the retina and choroid);
- deformation auricles;
- premature delivery or miscarriage;
- lower fetal body weight;
- decrease in mental and physical development (in severe and prolonged duration of disease).
In the later stages of fetal injury risk is significantly reduced, but still there is a possibility of such complications:
- jaundice of the newborn;
- hepatosplenomegaly (enlarged liver and spleen);
- pneumonia;
- formation petechiae (petechiae);
- fetal growth retardation.
Unfortunately, in the future, these children are at risk of hearing loss, epilepsy, mental retardation and physical disabilities, visual impairment, learning difficulties.
Treatment of congenital infection in neonates is performed with the same medications that the woman during pregnancy. Statistics show that most children are born healthy.
Infection with CMV infection in the third trimester is very rarely leads to impaired mental and physical development of the child (1 in 1000). The concentration of IgM in cord blood is usually low, the baby looks healthy.
Due to the risk of serious complications in pregnant women with CMV infection should be complex treatment preventive and diagnostic measures aimed at reducing the likelihood of congenital infection the fetus.
Forecast
Completely impossible to get rid of the infection, but the symptoms can be eliminated. In most cases, the disease does not manifest itself for several years and is not harmful, and makes itself felt only when immunodeficiency.
Therefore, it is important to maintain health, to conduct complex diagnostic and therapeutic measures, as well as strengthen the immune system.
Some studies in pregnancy
- Smears during pregnancy.
- Tests during pregnancy by trimester.
- Ultrasound during pregnancy.
- Urinalysis in pregnancy.
- Coagulation.
- Installing pessary.
- Glucose tolerance test.
- Homocysteine in pregnancy.
- Amniocentesis.
- Anesthesia during childbirth.
- Fetal CTG (cardiotocography)
- Cordocentesis.
- Epidural anesthesia during childbirth.
