During pregnancy, cytomegalovirus is positive. Cytomegalovirus during pregnancy: positive and negative result

The perinatal period occupies 0.5-0.6% of the total duration of our life, but it is precisely its course that determines human health in subsequent years. A particularly dangerous condition during pregnancy is cytomegalovirus. This pathology can cause the development of various complications in the fetus, and sometimes even provoke the death of an unborn baby in the womb.

Cytomegalovirus and its features in the first, second and third trimesters of pregnancy: the probability of having a healthy baby

One of the most common infections during pregnancy is cytomegalovirus. Cytomegalovirus is a representative of type 5 herpes viruses, which consists of double-stranded DNA and belongs to the group of TORCH infections (together with toxoplasmosis, rubella, herpes simplex, hepatitis and HIV).

Virus particles can be found in human biological fluids - saliva, blood, urine, vaginal secretions, semen, tears, breast milk, and even in red bone marrow cells.

To date, it is known that from 20 to 90% of pregnant women are infected with cytomegalovirus. It is very dangerous for the fetus when the expectant mother first encounters the causative agent of the infection during the gestation period.

Features of the manifestation of the disease depend on the time of infection with the pathogen, the state of reproductive health and the course of pregnancy in the mother. In case of infection:

• up to 12 weeks of gestation, spontaneous miscarriages, the formation of congenital malformations are possible;
• in the early fetal period (up to 28 weeks) - congenital malformations in the fetus, intrauterine growth retardation, missed abortion, premature birth of a child with clinical manifestations of infection, stillbirth are possible;
• in the late fetal period (from 28 to 40 weeks) - leads to the birth of a child with non-specific clinical manifestations, which greatly complicates timely diagnosis and treatment.

Severe consequences can be avoided with timely detection of the virus. Therefore, it is very important to plan pregnancy and identify any infections before conception, as well as regular visits to the doctor during gestation. Proper therapy will help the baby be born healthy, in which case he will only be a passive carrier of the virus.

Acute and chronic forms of pathology: is conception possible?

There are two forms of the course of infection - acute and chronic, which are determined in part by the clinical picture, but laboratory methods play the main role in the diagnosis. They confirm the type of disease.

Pregnancy can occur both in the acute and chronic periods (with natural and in vitro fertilization), but this is highly undesirable without proper treatment before conception.

In the chronic course of the disease, a certain amount of protective antibodies have already been developed in the woman's body, which prevent the penetration of virus particles through the placenta and reduce the possibility of infection of the fetus to 1%.

Cytomegalovirus infection during pregnancy - video

Carriers and routes of transmission of cytomegalovirus

Cytomegalovirus infection or cytomegalovirus is often referred to as the "kissing disease". But since viral particles can be found not only in saliva, but also in other biological fluids, you can become infected with the pathogen:

• sexually - through semen, vaginal secretion. You can also become infected through unprotected oral and anal sex;
• household way - through saliva. It is possible to transmit the virus by airborne droplets, when using one toothbrush, dishes;
• transplacental - from a sick mother to a fetus in the acute period of the disease;
• hematogenous - with blood transfusion or red bone marrow transplantation;
• vertical transmission route - is provided during breastfeeding and during childbirth, when the fetus passes through the birth canal of an infected mother (the most dangerous route of transmission, as it also leads to congenital cytomegalovirus infection and the development of defects).

The source of infection in most cases is not a passive virus carrier, but a person with an acute form of cytomegaly.

Symptoms of cytomegalovirus infection in pregnant women: the effect of the virus on various organs

The clinical picture during infection with cytomegalovirus is nonspecific. The symptoms that a pregnant woman experiences may resemble those of a respiratory viral illness or the flu. Pathology manifests itself:

• an increase in body temperature up to 38 0 С, in rare cases it can rise by 0.5–1 0 С higher;
• sore throat, perspiration;
• pain in the muscles;
• general weakness, headache;
• sometimes develops a violation of the stool - diarrhea.

The duration of these symptoms can indicate the development of cytomegalovirus infection, since, unlike SARS or influenza, their duration is up to 6 weeks.

In pathological conditions of immunity, generalized forms of the disease can rarely occur with damage to many body systems:

• inflammation in the kidneys, pancreas, liver;
• damage to the gastrointestinal tract;
• involvement in the pathological process of lung tissue, eyes;
• damage to the brain and peripheral nervous system is considered a very serious manifestation of cytomegaly, which leads to paralysis and death.

The chronic course of cytomegalovirus infection is not clinically manifested, the virus is in the body and multiplies throughout a person's life.

Diagnosis of the disease: blood test, cytological examination of the smear, detection of antibodies

If infection with cytomegalovirus occurred during pregnancy, then the following diagnostic methods are carried out to confirm the disease:

• complete blood count - will show a decrease in the level of erythrocytes, an increased number of leukocytes and platelets;
• biochemical analysis - venous blood is examined, where a high level of liver enzymes (transaminases), proteins of the acute phase of inflammation (C-reactive protein), fibrinogen B is observed;
• PCR (polymerase chain reaction) is a more specific diagnostic method, since it determines virus DNA molecules in blood, urine, saliva and other body fluids with an accuracy of 98%. Unfortunately, the study does not indicate an acute or chronic course of the disease, but only determines the genomic particles of the pathogen;
• cytological examination - under a microscope, a blood or saliva smear is examined, in which giant binuclear cells altered by cytomegalovirus are found;
• serological diagnostics - the method determines the presence of antibodies (immunoglobulins) to cytomegalovirus in the blood, which correspond to an acute or chronic infection. Antibodies Ig G are present in the chronic phase of the disease, and Ig M - in the acute.

A study for the presence of cytomegalovirus infection and other diseases from the TORCH group of infections for both a man and a woman must be performed 3 months before the planned pregnancy in order to avoid the pathology of the development of the unborn child or termination of pregnancy.

Options for the course of pathology depending on the level of immunoglobulins: positive, negative, doubtful results - table

IgG	Ig M	Meaning
value within the normal range	not found	the pregnant woman has not been exposed to the virus
increased amount	not found	the woman has previously suffered an acute phase of cytomegalovirus infection or is a latent carrier of the pathogen
value within the normal range	the amount of immunoglobulins above the norm	primary infection of a pregnant woman with a virus
increased amount	increased amount	the result is unreliable, the study must be repeated

Treatment of pregnant women with cytomegalovirus infection: is it possible to cure the pathology completely

To date, there are no generally accepted treatment regimens for cytomegaly. The volume of therapy for women depends on the duration of the disease, the severity of the condition and immune disorders. Treatment should be carried out under the control of a complete blood count, biochemical studies and serological parameters.

The purpose of using medications is to inactivate the virus, since there are no drugs effective in terms of completely ridding the body of cytomegalovirus infection.

The mandatory treatment regimen for the acute period of cytomegaly includes:

• drugs with a high content of anticytomegalovirus immunoglobulins - Cytobiotek, which is available as a solution for injection, Intraglobin;
• agents with direct antiviral action - Ganciclovir, Acyclovir, Valtrex;
• with a recurrent course of the disease, immunostimulants are used in therapy - Decaris, vitamins C, E and Folic acid;
• restorative therapy - Hofitol, Cocarboxylase.

A decrease in the level of Ig M indicates positive results from the drugs.

Preparations for the treatment of cytomegaly - photo gallery

Intraglobin - a drug with a high amount of anticytomegalovirus immunoglobulins Ganciclovir - destroys viral particles in a woman's body
Decaris - stimulates the immune system
Hofitol - prescribed as a general strengthening drug

Complications and consequences of the disease: abortion, fetal anomalies

Cytomegalovirus infection is often the cause of recurrent miscarriage. A woman may be unaware of the presence of the virus in her body and suffer from infertility.

With the development of intrauterine cytomegaly, the born child has:

• anomalies in the development of the brain (hydro- or microcephaly);
• increased bilirubin levels, enlarged liver and spleen at 2–3 weeks of age;
• deafness, blindness, diseases of the kidneys and intestines.

About 10% of children who have symptoms of congenital cytomegalovirus infection die in the first months of life. Mental retardation and deafness are observed in 60–85% of babies with clinical manifestations of diseases from birth and in 20% with asymptomatic pathology.

Prevention of cytomegalovirus infection: hygiene, pregnancy planning, exclusion of casual sex and other recommendations

There is no 100% protection against the virus, but by adhering to preventive measures, you can significantly reduce the risk of developing the disease:

• observe the rules of hygiene, keep the body clean and do not use other people's personal belongings;
• avoid casual sex and unprotected sexual intercourse;
• timely treat foci of chronic infection, which reduce immune defense mechanisms;
• an important role is played by a rational balanced diet and a sufficient amount of vitamins, which also strengthen the immune system;
• plan pregnancy and conduct a thorough examination of the body for the presence of infectious processes before conception;
• being pregnant, avoid crowded places and at the first signs of general weakness and fever, contact a specialist.

Cytomegalovirus during pregnancy is a fairly common infection that is found in many women. Consider the main causes of cytomegalovirus infection, symptoms and what danger it poses during the period of bearing a child.

ICD-10 code

B25 Cytomegalovirus disease

Causes of cytomegalovirus during pregnancy

The causes of cytomegalovirus during pregnancy are varied, but they are all associated with weakened protective functions of the woman's immune system. First of all, it is worth knowing that CMV is congenital and acquired. The congenital form can be acute and chronic. And acquired - latent, acute, generalized or mononucleosis. There are several ways of transmitting CMV from person to person, that is, the causes of infection with cytomegalovirus during pregnancy:

• Airborne.
• Contact or household - infection occurs only if the virus is in active form. The infection enters the body through saliva during a kiss, when using someone else's toothbrush, and even through dishes.
• Transplacental - poses a danger to the fetus and the normal course of pregnancy. Infection is also possible when the baby passes through the birth canal (if the baby is full-term, then there is no danger). The breast milk of a sick mother can also cause infection of the child.
• Sexual - the main way of infection among the adult population. The virus enters the body through genital, oral or anal contact without the use of a condom.
• With poor hygiene - cytomegalovirus can enter the human body through contact with urine or stool containing CMV. In this case, hand hygiene is of particular importance, since the virus enters the mouth due to poorly washed hands.
• Hemotransfusion - infection occurs during the transfusion of donor blood and its components, the use of donor eggs or during transplantation of organs and tissues.

From 45% of people in the world have antibodies to CMV infection, that is, they are seropositive. The older the person, the higher the likelihood that he is immune to cytomegalovirus. In Switzerland, about 45% of the population are seropositive to infection, in Japan about 96%, but in Ukraine from 80-90%. Primary CMVI manifests itself in 6-12 years, that is, in childhood. In this case, the infection can be latent, that is, it can enter the child's body during breastfeeding, during passage through the birth canal, and more. The causes of cytomegalovirus during pregnancy are varied, as the infection can be in the blood, semen, urine, saliva, tears, and even in vaginal secretions.

How does cytomegalovirus affect pregnancy?

How cytomegalovirus affects pregnancy, and to what extent CMV infection is dangerous is a question of interest to many expectant mothers. During pregnancy, a woman's immune system is significantly weakened. This happens for obvious reasons, so that the body does not reject the embryo (since it perceives it as a foreign object). During this period, the risk of infection with cytomegalovirus infection increases. If the virus is in the body in a latent state, then during the gestation period, it is activated and aggravated.

The disease is very dangerous, because in case of intrauterine infection of the fetus, it can lead to its death or various disorders in the development of systems and organs. Infection of the embryo can occur during conception, through semen. But most often, infection occurs during childbirth, when passing through the birth canal. At the same time, intrauterine infection is much more dangerous for the fetus, in contrast to infection through breast milk.

If a pregnant woman becomes infected with CMVI in the first trimester of pregnancy, then this leads to sudden miscarriages, stillbirths and miscarriages. If the baby survives or infection occurs in the later stages of gestation, then the child receives a congenital cytomegalovirus infection, which makes itself felt immediately after birth or in the first years of life. Symptoms of CMV during pregnancy are manifested as fever, general malaise and weakness, or absent altogether.

• The main danger of the virus is that it may not make itself felt, that is, it may be asymptomatic. In this case, the infection can be detected by the results of blood tests. Since cytomegalovirus crosses the placental barrier, it belongs to the group of diseases for which a woman must be tested at the stage of planning a child.
• Cytomegalovirus can cause severe pregnancy. Very often, the infection causes miscarriages and premature detachment of the placenta. In addition, the risk of fetal hypoxia increases, which leads to abnormal development and premature birth.
• If a woman received CMV during pregnancy, and the virus caused serious complications, an artificial termination of pregnancy is performed. But before that, doctors conduct a deep virological study to study the placenta and fetus. Since even in the most critical situations, there is a chance to save the child.
• Especially dangerous is cytomegalovirus during pregnancy, which occurs along with herpes, rubella or toxoplasmosis. In this case, the consequences of the infection will negatively affect both the condition of the expectant mother and the child.

If a woman becomes infected with cytomegalovirus for the first time during pregnancy, then this indicates a primary infection. This condition is very dangerous, since the virus can enter the body of the fetus and cause a number of complications in its development. In order to determine whether the cytomegalovirus has entered the fetal body, a woman undergoes the following examinations:

• Ultrasound procedure

Allows you to identify abnormalities in the development of the fetus, which are caused by cytomegalovirus: microcephaly, intrauterine growth retardation, ascites, oligohydramnios, abnormalities in the development of the brain.

• Amniocentesis

This examination is an analysis of amniotic fluid. The method is considered one of the most effective for detecting intrauterine CMVI. The study is possible from the 21st week of pregnancy, but not earlier than 6-7 weeks after the alleged infection. With a negative analysis, we can say that the child is healthy. If the analysis is positive, then the woman is given a quantitative PCR test for cytomegalovirus. Moreover, the higher the viral load, the worse the prognosis for pregnancy. Consider the possible results of the study:

• The amount of cytomegalovirus DNA ≥10 * 3 copies / ml - 100% probability that the virus has entered the fetus.
• The amount of cytomegalovirus DNA
• The amount of cytomegalovirus DNA ≥10 * 5 copies / ml - there is a high probability of having a child with symptoms of congenital CMVI and pathologies caused by the virus. In this case, the doctor may prescribe an abortion.

But do not panic in advance, since a child not always infected with cytomegalovirus has health complications. All children with CMV are under constant dispensary supervision. However, in some cases, the virus, infecting the fetus in the womb, causes its death. In some infected newborns, serious pathologies in physical and mental development begin.

Symptoms of cytomegalovirus during pregnancy

Symptoms of cytomegalovirus during pregnancy depend on the type and form of infection. Very often, CMV does not manifest itself, this happens with a strong immune system. In this case, the virus remains in a latent state and manifests itself when the body's forces weaken. Many infected perceive the activation of the infection as a common cold. But not everything is so simple, since with such a "cold" the main lesion falls on the central nervous system, kidneys, lungs, heart, liver.

• In women, cytomegalovirus causes cervical erosion, inflammation of the fallopian tubes and ovaries, and cervicitis. The inflammatory process can affect the ovaries, accompanied by severe pain in the lower abdomen and whitish-bluish discharge. In this case, in pregnant women, the infection may be asymptomatic.
• In men, CMV causes symptoms of a cold, which are accompanied by inflammation of the organs of the genitourinary system. Diseases of the urethra and testicular tissue may worsen. Due to cytomegalovirus, a man feels pain and discomfort when urinating
• Consider the general symptoms of cytomegalovirus during pregnancy, which, as a rule, are determined using differential diagnosis:
• Acute respiratory viral infection - a woman complains of weakness, fatigue and general malaise, frequent headaches, inflammation of the salivary glands, increased sweating, whitish plaque on the tongue and gums.
• Damage to the genitourinary system - symptoms of a chronic non-specific inflammatory process appear. If doctors fail to establish the viral nature of pathological symptoms, antibiotic therapy is performed, which, as a rule, does not give the expected results.
• If a woman has a generalized form of cytomegalovirus infection, then it is accompanied by damage to the internal parenchymal organs. Most often there is inflammation of the adrenal glands, kidneys, pancreas, spleen. Because of this, at first glance, causeless bronchitis and pneumonia, which are difficult to treat with antibiotics, are becoming more frequent.
• Cytomegalovirus infection is accompanied by a significant decrease in the immune status, a decrease in platelets. Damage to the walls of the intestine, peripheral nerves, blood vessels of the eyes and brain is possible. It is not uncommon for cases of enlargement of the submandibular and parotid salivary glands, skin rash and exacerbation of inflammatory diseases of the joints.

Very often, CMV strikes during adolescence or childhood, when the immune system is not strong enough. At the same time, in 90% of cases, the viral infection is asymptomatic. The incubation period takes from 20 to 60 days, that is, after entering the body, the virus does not immediately make itself felt. After infection, cytomegalovirus lives and multiplies in the cells of the salivary glands. At the end of the incubation period, CMV causes a short-term viremia, which is accompanied by inflammation of the regional lymph nodes, an increase in the salivary glands, increased salivation and plaque on the tongue. Due to severe intoxication, headaches, weakness, general malaise and fever occur.

Cytomegalovirus penetrates into mononuclear phagocytes and leukocytes and can replicate. Infected cells multiply, increase in size and carry viral inclusions in their nuclei. All this suggests that CMV can remain in a latent state for quite a long time, especially if the lymphoid organs have been affected. In this case, the duration of the disease can be from 10 to 20 days.

The consequences of cytomegalovirus during pregnancy

The consequences of cytomegalovirus during pregnancy can be fatal for the child. That is why every woman should be screened for CMVI even before conception. This will allow you to find out whether it is worth fearing or just strengthening the immune system is enough. The consequences can make themselves felt both with primary cytomegalovirus infection and with transplacental infection.

The maximum danger to the fetus occurs in the first 4-23 weeks of pregnancy. The minimum danger to the unborn child occurs when CMV is reactivated during the gestation period. At the same time, every woman should remember how serious the consequences of cytomegalovirus during pregnancy can be. CMV in a future mother can cause the following pathologies in a child:

• Fetal death, miscarriage, placental abruption and artificial birth.
• Heart defects and pathologies of the cardiovascular system.
• Loss or impairment of hearing and vision.
• Mental retardation and underdeveloped brain.
• Hepatitis, enlarged liver, jaundice.
• Pathological lesions of the central nervous system.
• Pathologies of the musculoskeletal system.
• Enlargement of the spleen and liver.
• Intracerebral calcifications, microcephaly.
• Petechiae, dropsy, convulsions.
• ventriculomegaly and others.

Cytomegalovirus during pregnancy can be a serious health hazard to the baby. The probability that the virus will lead to the above consequences is 9%, and with primary CMV or its reactivation, 0.1%. That is, many women who are diagnosed with cytomegalovirus infection during pregnancy have absolutely healthy children.

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Diagnosis of cytomegalovirus during pregnancy

Diagnosis of cytomegalovirus during pregnancy should be carried out at the planning stage of conception. To detect the virus, a study of blood, urine, saliva, scrapings and swabs from the genitals is carried out. During pregnancy, CMV is detected using a blood test. It is difficult to diagnose the infection due to the fuzzy clinical picture. Therefore, analyzes are carried out to detect antibodies. If the analysis revealed the presence of specific antibodies to CMVI, then this indicates the presence of the virus in the body.

The main methods for diagnosing cytomegalovirus:

• Cytological - reveals enlarged cells in breast milk, urine sediment, saliva and other secretory fluids.
• Serological - cytomegalovirus antibodies are detected using IgG and IgM immunoglobulins. If IgM was detected in a pregnant woman, then this indicates a recent infection, which requires a detailed study. An analysis of the umbilical cord blood of the embryo is carried out to detect immunoglobulins. If the analysis showed IgM, then this indicates that the child is infected with CMV.
• Molecular biological - is carried out to detect cytomegalovirus DNA in the cells of the body.
• Virological is a rather expensive and time-consuming diagnostic method. For its implementation, the pathogen is cultivated on its nutrient medium.

Of all the above diagnostic methods, serological is most often used. If antibodies to cytomegalovirus are present in the blood, that is, igg is positive, then this indicates a high immunity in the pregnant woman. In most cases, CMV proceeds latently.

With a negative diagnosis for cytomegalovirus, pregnant women are advised to conduct a study every trimester, since expectant mothers are at risk. In any case, the absence of antibodies is a potential threat to a normal pregnancy. Babies born from a sick mother are required to be diagnosed in the first days of life for the presence of antibodies. Moreover, if IgG antibodies were detected in a newborn in the first three months, then this is not a sign of congenital cytomegalovirus. But the presence of IgM indicates acute CMVI.

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Analysis for cytomegalovirus during pregnancy

An analysis of cytomegalovirus during pregnancy is a must for every expectant mother. This is because CMV infection in the first 20 weeks of pregnancy can lead to miscarriage and fetal death. But even in the last months of gestation, cytomegalovirus is very dangerous. Therefore, to avoid the severe consequences of the disease, every woman is tested for cytomegalovirus.

Laboratory diagnosis of CMVI consists of a study of urine and saliva, a polymerase chain reaction, and a serological study of blood serum. Let's consider each of the analyzes in more detail.

• Cytological studies of urine and saliva sediment

Urine and saliva of a pregnant woman is examined under a microscope to detect huge cells characteristic of CMV.

• PCR or polymerase chain reaction

Diagnosis is based on the determination of the DNA of the infection, which is contained in viral cells and is the carrier of hereditary information in blood cells. For PCR, urine, scrapings, sputum or saliva are used.

• Serological studies of blood serum

The analysis is carried out to detect antibodies specific for CMV in the blood. To date, the most accurate is the ELISA enzyme immunoassay. Using this analysis, you can determine the various types of immunoglobulins IgG, IgM and their avidity.

Norm of cytomegalovirus during pregnancy

The rate of cytomegalovirus during pregnancy depends on the individual characteristics of the woman's body. That is, there is no single indicator of the norm. For example, if a man has no antibodies to the virus in his blood, then this is very good. But this does not mean that he is not infected and will not transmit the virus to a woman. The absence of antibodies in the blood of a woman is a threat to CMV. A previously uninfected pregnant woman is at risk and can become infected with cytomegalovirus. The absence of antibodies significantly increases the risk of intrauterine infection. Pregnant women who already have children attending kindergartens or schools are especially at risk. Since CMV is constantly circulating in children's groups.

To detect antibodies to the virus during pregnancy, a woman is tested for TOCH infection. It is worth noting that when it enters the body, the virus remains there forever. Only antibody tests can reveal the relationship between the body and cytomegalovirus. When transcribing the results of blood tests, special attention should be paid to the following:

Indicators		Avidity	Deciphering the results
		Do not define

Normal is IgG within normal limits and the absence of IgM. Such results indicate that the female body has never been in contact with the virus. If IgG is higher than normal, but IgM is not, then the woman's body contains the virus in a latent state. In this case, in the presence of provoking factors and a weakened immune system, the likelihood of infection of the fetus in the womb or the child during the birth process is minimal. If IgM is higher than normal, then the woman survived the initial infection, but pregnancy can trigger the virus again and cause intrauterine infection of the fetus.

IgG is individual for each woman, so it can have different values ​​in different women. Doctors recommend taking tests even before pregnancy, this will make it possible to compare indicators and determine the risk of infection or exacerbation of cytomegalovirus. Since IgM is not detected in 10% of cases, therefore, all attention is focused on the value of IgG.

IgG to cytomegalovirus during pregnancy

IgG to cytomegalovirus during pregnancy determines the avidity of antibodies. This parameter allows you to find out how long ago the infection occurred. At the same time, the higher the avidity, the earlier the infection occurred, which means that the situation is safer for the unborn child. If the avidity is high, that is, more than 60%, then there is no threat to pregnancy, if the indicator is below 50%, then the infection occurred less than three months ago and is dangerous for the pregnant woman.

In order to detect the presence of an infection, a woman's blood is taken every trimester and tested for the presence of IgM antibodies. In primary CMV, IgG appears in the background of IgM. If IgG increases and IgM is not detected, then this indicates an exacerbation of cytomegalovirus. If IgG is detected in a small amount, then this indicates the presence of a virus in the mother's body, which means that there is a risk of infection of the fetus.

• IgG to cytomegalovirus during pregnancy allows you to confirm the primary infection. During primary infection, IgG antibodies in the blood appear later than IgM and are characterized by low avidity.
• The study of IgG antibodies is included in the complex of laboratory tests for TORCH infections. In addition to cytomegalovirus, a woman is checked for herpes infection, rubella and toxoplasmosis.
• All children up to six months of age and older have IgG antibodies in their blood that are of maternal origin. This makes it difficult to interpret IgG avidity results.
• If a woman is immunocompromised, then the level of antibodies is very low and cannot be determined in the blood. For diagnostics, other biological fluids are used and PCR is performed.

Cytomegalovirus IgG positive in pregnancy

Cytomegalovirus IgG positive during pregnancy is not uncommon, as up to 90% of the population has a similar result. Therefore, this result can be safely considered the norm, and not pathologies. In many people, CMV infection occurs during childhood. Infected children can shed the virus for a long time, so pregnant women with a weakened immune system are not recommended to have close contact with children or be in children's groups.

A positive IgG is essential for all women who are planning a pregnancy. In this case, the risk of serious pathologies in a child with activation of the virus is 0.1%, and with primary infection of the mother and fetus, 9%. With primary infection, the incubation period and immune restructuring take from 15-60 days, depending on the course of pregnancy and the individual characteristics of the woman's body.

The protective reaction of the body is based on the production of IgM and IgG antibodies, which are responsible for the lysis and replication of intracellular cytomegalovirus. Cytomegalovirus IgG has averaged norms in IU/ml. So, if the value is greater than 1.1, then this indicates the presence of an infection in the body. If the indicator is less than 0.9, then the result is negative, that is, nothing threatens the woman and the normal course of pregnancy.

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IgM to cytomegalovirus during pregnancy

IgM to cytomegalovirus during pregnancy allows you to find out if the immune system has overcome the virus or is it active at the moment. The presence of IgM antibodies indicates that the primary infection has become acute or the virus has recurred. If a woman did not have IgM antibodies to cytomegalovirus before pregnancy, then their appearance in the blood is a primary infection. But in some cases, it is rather difficult to determine the presence of a virus in the blood only by IgM, since antibodies persist for 10-20 weeks or longer after the illness.

It is very important to identify primary cytomegalovirus, since primary infection can lead to intrauterine infection of the fetus. In this case, when deciphering the analyzes, the value of IgG and their properties are taken into account. The question of the treatment of cytomegalovirus with positive IgM antibodies depends on several factors:

• The presence of symptoms - if the symptoms of the infection are completely absent, but CMVI is detected in the analysis, then the pregnant woman is not prescribed antiviral drugs.
• The asymptomatic course of CMV indicates the high status of the immune system, which independently coped with the infection. In order to speed up the process of producing antibodies, a pregnant woman is prescribed immunomodulators and vitamins, which have general strengthening properties and increase immunity.
• With pronounced symptoms of cytomegalovirus, a woman is given antiviral treatment. Vitamin therapy is essential.

Cytomegalovirus IgM positive during pregnancy

Cytomegalovirus IgM positive during pregnancy, can only be determined using the PCR or ELISA method. Diagnosis using ELISA allows you to detect the presence of antibodies in the blood, that is, the reaction of the immune system to an infectious agent. If a pregnant woman has an elevated level of IgM antibodies, then this indicates a primary infection and exacerbation of cytomegalovirus infection. In this case, additional tests are performed to determine the concentration of both immunoglobulins.

A positive result for IgM and IgG indicates a secondary exacerbation of cytomegalovirus. At the same time, in 90% of the population, IgG has a positive result and this is considered the norm. But with the result of an analysis with a positive IgM, women are not recommended to become pregnant until this titer is normalized. If the condition was diagnosed during the gestation period, a gynecologist's consultation and medical intervention are required.

A certain amount of IgM is an indicator of the activity of cytomegalovirus. IgM indicates the acuteness of the infection, reinfection or reactivation. If a positive IgM is detected in a seronegative patient, then this indicates the primacy of the disease. IgM antibodies appear only with endogenous reactivation of CMVI. Timely detection of antibodies allows for comprehensive monitoring, study of the dynamics of cytomegalovirus and its clinical manifestations. If a pregnant CMV has taken a severe form, then the production of antibodies is greatly slowed down. This also applies to people with weakened immune systems.

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Avidity for cytomegalovirus during pregnancy

Avidity for cytomegalovirus during pregnancy is a kind of assessment of the ability of antibodies to bind to CMV to neutralize the virus. To determine avidity, ELISA diagnostics is performed. This research method allows you to identify the presence of antibodies in the blood, their content and affinity. Avidity is determined by the values ​​of IgG and IgM, which allow you to know about the maturity of antibodies.

Indicators		Avidity	Deciphering the results
		Do not define	Seronegativity, the virus is absent in the female body. Nothing threatens the normal development of the fetus.
			There is a primary infection with CMV and the risk of infection of the fetus.
		Threshold zone (average)	Primary infection is in the last stage, the risk of infection of the fetus is high.
			Cytomegalovirus is in a latent state, the risk to the fetus is minimal.
			CMVI at the stage of reactivation, high risk of infection of the fetus.

Avidity gives an idea of ​​the degree of binding of antibodies and antigens, the specificity of their interaction and the number of active centers. When the body first comes into contact with cytomegalovirus, the immune system begins to produce native antibodies. Such antibodies have a low degree of interaction with a pathogenic agent. Depending on the spread of the virus in lymphocytes, mutations of the genome, which is responsible for the synthesis of immunoglobulins, are possible. Of the new antibodies, those that are similar to the proteins of the microorganism are isolated, that is, they can neutralize it. This indicates that avidity is increasing.

Avidity data is an important indicator of the stage of infectious development of cytomegalovirus. If the avidity is below 30%, then this indicates the spread of the virus throughout the body and primary infection. Avidity greater than 60% indicates a past infection, that is, the virus is in a latent state. Avidity at the level of 30-50% is a re-infection or cytomegalovirus is in the active stage.

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Cytomegalovirus in a smear during pregnancy

Cytomegalovirus in a smear during pregnancy can be determined from the first days of conception. And this is not surprising, since CMV belongs to the herpesvirus family. That is, the DNA of infectious agents, once it enters the human body, cannot be destroyed. An infection can be detected with a smear from the vaginal mucosa or during the initial examination. According to statistics, laboratory tests detect CMVI in every second woman. Such results indicate that the virus is subject to detailed diagnostics, since it can have both a latent and an acute state.

The danger of a detected cytomegalovirus in a smear in a pregnant woman is that the infection can cause a complex disease - cytomegaly. In women with a healthy immune system, even if they are carriers of CMV, the virus is in a latent state and does not manifest itself. In this case, when taking a smear, antibodies to type V herpes will be detected. If during gestation or during the birth process no activation of the virus occurs, then the fetus will not become infected, that is, the child is not in danger.

• The risk of infection occurs at a time when the pregnant woman's body is under stress. The bad habits of a woman, which negatively affect her state of health, can reactivate cytomegalovirus.
• Various chronic diseases and pathologies, long-term treatment or therapy that weakens the immune system pose a risk of infection with CMVI. Infection of the child will inevitably come, since the already weakened immune system of the woman will not be able to suppress the virus. The symptomatology of cytomegalovirus is similar to SARS, only the duration of the respiratory infection lasts at least 5-6 weeks.
• Cytomegalovirus poses a great danger in the first trimester of pregnancy. Since during this period the infection can provoke a miscarriage. With CMV reactivation in the last stages of pregnancy, placental abruption, miscarriage, or premature birth are possible.

But the presence of cytomegalovirus does not always mean that the child will be infected. It depends on the behavior of the pregnant woman in whose smear CMVI was found. A woman should follow the doctor's instructions and follow all recommendations. As a rule, a woman is prescribed antiviral drugs and immunomodulators. From the expectant mother is required to closely monitor the state of health, support the immune system and eat a healthy balanced diet. Compliance with these conditions is especially important for women who have cytomegalovirus in a latent state. If the expectant mother leads a healthy lifestyle and monitors her health, then the chances are high that the child will be born healthy and without pathologies caused by cytomegalovirus.

• There are generalized and localized forms of the disease caused by cytomegalovirus. With a localized form, pathological processes are found only in saliva, and with a generalized form, changes affect all organs and systems.
• CMVI belongs to the group of reproductively dangerous infections that are part of the TORCH complex (Toxoplasma, Rubella, Cytomegalovirus, Herpes). A TORCH examination is carried out six months before pregnancy in order to find out the state of the future mother's immune system and, if necessary, to carry out immunotherapy and other therapeutic measures.

To diagnose cytomegalovirus DNA and assess the risk of developing an early form of CMV, special tests are used: anti-CMV-IgG and anti-CMV-IgM. The material for analysis is blood, and the PCR method detects viral DNA. If, according to the results of the analysis, a DNA fragment of cytomegalovirus is found in a pregnant woman, then this indicates infection. If no DNA is found, this may indicate that there are no DNA fragments or that during the study, biological material was taken with an insufficient amount of cytomegalovirus DNA for the study.

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Treatment of cytomegalovirus during pregnancy

Treatment of cytomegalovirus during pregnancy is carried out if the virus poses a real threat to the normal development of the fetus. In other cases, the woman is shown preventive measures. To date, there are no drugs that have made it possible to permanently get rid of CMVI. No drug destroys the infection in the human body. Therefore, the main goal of treatment is to eliminate the symptoms of cytomegalovirus and keep it in a latent state.

• Expectant mothers who have been diagnosed with cytomegalovirus are prescribed vitamin and immunomodulatory drugs to strengthen the immune system. But such treatment is possible only if the CMV is in a passive state.
• Herbal teas, natural juices, fruits and vegetables are used to support the immune system. A pregnant woman should monitor her diet, nutrition should be balanced. The attending physician will help you choose a collection of herbs that will be safe for the child and will not provoke a miscarriage, but at the same time will strengthen the woman's immunity.
• If the cytomegalovirus is in an active state, then antiviral agents are used for treatment, since vitamins and immunomodulators will not cope with the disease. In this case, the main goal of treatment is to avoid possible complications. Treatment will allow you to endure and give birth to a healthy baby without deviations and pathologies.

Very often, CMVI is accompanied by symptoms of acute respiratory viral infections and other concomitant diseases. In this case, the success of the treatment of cytomegalovirus depends on the effectiveness of the treatment of the resulting lesion. For this, antiviral and immunomodulatory drugs are used, in combination with drugs prescribed for the treatment of the disease. It is strictly forbidden to engage in the treatment of cytomegalovirus on your own. Since only a doctor can choose a safe, but effective drug.

Despite the fact that CMV can cause serious abnormalities in the development of the fetus, termination of pregnancy is not carried out in all cases of infection. The doctor may suggest this procedure in case of infection during pregnancy and if anomalies and pathologies in the development of the fetus are found on ultrasound, which will lead to the disability of the child. Another indication for abortion is the result of an analysis of amniotic fluid, which shows a high risk of developing congenital CMVI.

Treatment of cytomegalovirus during pregnancy involves drug therapy. Consider the main drugs used for cytomegalovirus:

• human anticytomegalovirus immunoglobulin

The drug contains CMV antibodies obtained from the blood of people who have recovered from the virus and have developed immunity. According to studies, during pregnancy, this drug significantly reduces inflammation of the placenta and the risk of infection of the fetus. The drug is used for primary CMV (if infection occurred during pregnancy), when virus DNA is detected and with low avidity of IgG antibodies to CMV.

• Antiviral drugs

For antiviral therapy, Valtrex, Ganciclovil, Valavir and other drugs are used. The action of the drug is based on preventing the reproduction of the virus during pregnancy and reducing the viral load in the fetus.

• Immunomodulators

Of the drugs in this category, most often pregnant women are prescribed Viferon or Wobenzym. But the effectiveness of such drugs remains in question, since not all doctors consider it necessary to use immunomodulators for the treatment of cytomegalovirus during pregnancy.

Prevention of cytomegalovirus during pregnancy

Prevention of cytomegalovirus during pregnancy depends on the type and form of infection. There is no specific prophylaxis or vaccination, therefore, at the stage of pregnancy planning, a woman should be examined for the presence of CMV antibodies. Seronegative women (not having IgG antibodies) are advised to avoid potentially dangerous contacts: young children or a seropositive partner. If an infected woman has a child with intrauterine cytomegalovirus, then the next pregnancy can be planned no earlier than 2 years later.

The main method of prevention is personal hygiene. Since the spread of cytomegalovirus is possible through infected body fluids that come into contact with the hands and are absorbed through the mouth or nose. If a pregnant woman is in contact with children, it is recommended to adhere to hygiene practices, from disinfecting hands to changing diapers with gloves. Hand hygiene is an effective tool in preventing the spread of the virus.

Climate change has an excellent preventive effect. Studies have shown that pregnant women from large metropolitan areas are more susceptible to the virus than women from small cities. Simple rules of prevention will help protect against infection with cytomegalovirus during pregnancy, consider them:

• Practice good hygiene by washing your hands regularly with soap and water.
• If you have mononucleosis, you must undergo a mandatory test for CMV.
• Do not use other people's cutlery or bedding.
• Any form of herpes disease is an indication for testing for cytomegalovirus.
• To normalize the indicators of CMVI, it is recommended to drink herbal teas and carefully monitor your diet.

But even with the observance of all preventive measures, the risk of infection with cytomegalovirus of the mother and child remains. The possibility of infection depends on the conditions in which the pregnant woman is.

Prognosis of cytomegalovirus during pregnancy

The prognosis of cytomegalovirus during pregnancy is based on the form of infection. So with congenital CMV, the prognosis for the fetus is not favorable. If the infection has a generalized form, then the prognosis depends on the effectiveness of the treatment of the disease, which lowered the woman's immune system and activated the virus. If the cytomegalovirus is in a latent state, then the prognosis is favorable. Since the infection is not a threat to the mother and unborn child.

Cytomegalovirus during pregnancy is dangerous if it is in an active form. Since it can cause intrauterine infection of the fetus. When infected in the early stages of pregnancy, CMV causes a miscarriage, and in the later stages - serious pathologies. Of particular danger is the primary infection, in contrast to the activation of a long-existing infection.

Cytomegalovirus during pregnancy is not a direct indication for abortion or caesarean section. The active form of CMV should be alarming, and requires additional examinations.

Cytomegalovirus infection in most cases occurs in humans in a latent or mild form. The danger of cytomegalovirus is only for pregnant women. What should a future mother know about this disease?

Causes

The causative agent of the disease is cytomegalovirus (CMV) - a DNA-containing microorganism from the herpesvirus family. The infection is widespread throughout the world. In most cases, the virus enters the human body without causing any changes and visible manifestations.

Transmission of infection is carried out from person to person in several ways:

• airborne;
• fecal-oral;
• sexual;
• transplacental (vertical);
• parenteral.

The virus can pass through blood, urine, saliva and other biological fluids. The virus is tropic to the salivary glands, which is why cytomegalovirus infection is also called "kissing disease". Seasonality and outbreaks of the epidemic for CMV are not typical.

Cytomegalovirus is rapidly destroyed in the external environment under the influence of high temperature and other factors. After infection, specific antibodies are produced in the human body, which remain for life. The virus remains in human blood in a latent form. Activation of the infection is possible under the influence of the following factors:

• decreased immunity (including during pregnancy);
• exacerbation of chronic diseases;
• taking drugs that suppress the immune system.

An important point: CMV has a general immunosuppressive effect on the entire body. Under the influence of this virus, there is a decrease in the body's own defenses, even in the absence of clinical manifestations of the disease. The mechanism of this process is currently not fully understood.

Symptoms

Most people with cytomegalovirus infection are asymptomatic. The development of a complete clinical picture is typical only for newborns, as well as for people with congenital or acquired immunodeficiency. With a latent form of the disease, minimal symptoms similar to a common cold may appear.

Signs of CMV infection:

• moderate increase in body temperature;
• general weakness and lethargy;
• mild runny nose;
• sore throat;
• enlargement of the cervical lymph nodes;
• swelling and pain in the parotid salivary glands;
• enlargement of the liver and spleen.

Similar symptoms may persist for 4-6 weeks. Not all women attach importance to such features. In most cases, cytomegalovirus infection is mistaken for a protracted cold or SARS, especially in the cold season. Recovery occurs on its own without any special therapy.

In people with sharply reduced immunity, periodic exacerbation of CMV infection is possible with the development of complications:

• bronchitis;
• pneumonia;
• chorioretinitis (inflammation of the retina and choroid);
• lymphadenopathy (damage to the lymph nodes).

Despite the fact that pregnant women are at risk for developing any infection, such complications are rare among them. In most cases, the body of a healthy woman successfully copes with the disease, and the disease proceeds in a mild or latent form.

Cytomegalovirus often affects the pelvic organs. The disease is almost always asymptomatic and is detected only during laboratory examination. Signs of overt infection are nonspecific and rarely diagnosed. It is possible to activate a viral infection during pregnancy and the development of complications from the fetus.

Complications of pregnancy and consequences for the fetus

An important point: as the duration of pregnancy increases, the concentration of the virus in the urine and vaginal secretions increases. At the same time, the presence of a virus in the vaginal discharge does not indicate a mandatory infection of the fetus. The risk of infection is determined primarily by the presence or absence of specific antibodies in the mother's blood, as well as the peculiarities of the functioning of the placenta.

The maximum danger to the fetus is the primary infection of the mother during pregnancy. This form of the disease is detected in 0.5-4% of all women with CMV. Young women under 20 are at high risk. This category of expectant mothers does not always have time to meet with cytomegalovirus before conceiving a child, which means that their body does not have time to develop protective antibodies against a dangerous disease.

The risk of CMV transmission to the fetus during primary infection during pregnancy is 30-50%. In the case of repeated pregnancy in the presence of specific antibodies against CMV circulating in the blood, the risk of infection is reduced to 1-3%.

There is a direct relationship between the concentration of the virus in the urine and the likelihood of infection of the fetus. The more viral particles found during the examination, the higher the risk of infection of the baby in the womb. At the same time, the mother's body is not able to completely get rid of the virus even during treatment and thereby protect the child from infection during pregnancy.

Congenital cytomegalovirus infection

The probability of the formation of congenital CMV infection is 0.5-2.5%. Unlike other infectious diseases, the presence of antibodies against cytomegalovirus in the mother's blood does not guarantee protection for the fetus. In many cases, congenital CMV infection develops in the presence of specific antibodies.

The condition of the newborn depends on the gestational age at which infection with cytomegalovirus occurred. Of great importance is also the form of the disease in the mother. The most severe disturbances in fetal development occur with primary CMV infection during pregnancy. With the activation of an existing infection and the presence of specific antibodies, the consequences for the baby may not be so serious.

I trimester

If the embryo is infected in the early stages of its development, spontaneous miscarriage is possible. Termination of pregnancy most often occurs before 12 weeks of gestation. When examining a dead embryo, specific changes characteristic of cytomegalovirus infection are found in its tissues.

While maintaining pregnancy, the formation of various developmental anomalies is possible:

• microcephaly - underdevelopment of brain tissue and a decrease in the size of the skull;
• hydrocephalus - accumulation of fluid under the membranes of the brain;
• the formation of calcifications in the ventricles of the brain;
• chorioretinitis (simultaneous damage to the choroid and retina);
• an increase in the liver (due to the development of hematopoietic foci in it outside the bone marrow);
• malformations of the digestive tract.

Children infected in the early stages of fetal development often develop generalized intravascular coagulation. There are small hemorrhages on the skin. There is a decrease in the level of platelets, there are violations in the hemostasis system. This condition can be very dangerous and requires the mandatory help of specialists after birth.

Congenital CMV infection, transferred at an early stage, often leads to impaired intelligence in newborns. There may be no visible malformations of the brain in this case. Slowdown of mental and physical development is one of the expected long-term consequences of congenital cytomegalovirus infection.

II trimester

Infection at a period of 12-24 weeks rarely leads to the formation of congenital malformations of the fetus. Microcephaly and other brain changes are not typical. In some newborns, there is an increase in the liver and spleen, the formation of foci of extramedullary (outside the bone marrow) hematopoiesis. Protracted jaundice after birth is characteristic, as well as various pathologies of the blood coagulation system. Many babies are born with no visible signs of infection.

III trimester

Infection with cytomegalovirus for a period after 24 weeks does not lead to the appearance of defects in the internal organs. In this situation, congenital cytomegaly develops, accompanied by the appearance of such symptoms:

• enlargement of the liver and spleen;
• prolonged jaundice;
• hemorrhagic rash on the skin;
• hemorrhages in the mucous membranes, internal organs, brain;
• bleeding;
• progressive anemia;
• thrombocytopenia (decrease in the level of platelets in the blood).

The intensity of jaundice in CMV infection increases within 2 weeks, after which it slowly decreases over 4-6 weeks. Hemorrhagic rash on the skin and changes in the blood coagulation system persist during the first month of life. Enlargement of the liver and spleen lasts up to 8-12 months.

Against the background of congenital CMV infection, the following complications occur:

• encephalitis (damage to brain tissue);
• eye changes (chorioretinitis, cataract, optic nerve atrophy) with complete or partial loss of vision;
• pneumonia;
• kidney damage;
• changes in the cardiovascular system.

Many children are born without signs of cytomegalovirus infection and do not differ in any way from their peers.

Long-term consequences of congenital CMV infection:

• mental retardation;
• delayed physical development;
• complete or partial loss of vision;
• progressive hearing loss.

All of these complications appear in the first two years of a child's life. It is not possible to predict in advance the likelihood of such consequences.

Infection of a newborn is possible when passing through the birth canal. The probability of infection is up to 30%. Infection from mother to child is also possible through breast milk. In case of infection, the baby may develop a generalized CMV infection with damage to the internal organs and brain.

In most cases, manifestations of CMV infection in the fetus occur against the background of a pronounced decrease in the mother's immunity. At risk are women with chronic diseases, as well as those who received immunosuppressive therapy before conceiving a child.

Complications of pregnancy

Cytomegalovirus is the culprit of such conditions:

• polyhydramnios (with the simultaneous development of dropsy in the fetus);
• placental insufficiency;
• delayed fetal development;
• termination of pregnancy at any time.

In the case of placental insufficiency, the likelihood of intrauterine infection of the fetus increases significantly. The placenta ceases to fully fulfill its barrier function, and the virus enters the baby's blood. Symptoms of intrauterine CMV infection occur, leading to serious health problems in the future.

Diagnostics

Two methods are used to detect cytomegalovirus:

• serological (ELISA - determination of class M and G antibodies to CMV);
• molecular (PCR - detection of pathogen DNA).

Detection of IgM is a reliable sign of an acute infection or reactivation of a chronic disease. Detection of IgG indicates the presence of specific antibodies to cytomegalovirus. For a pregnant woman, the detection of IgG is a favorable sign and indicates that her body is able to cope with the infection. Detection of only IgM without IgG is a bad symptom, indicating a high risk of infection of the fetus and the formation of serious complications.

The determination of antibodies and DNA of cytomegalovirus is carried out for all women when registering during pregnancy. According to the indications, the doctor may prescribe a re-analysis at a later date.

Malformations of the fetus are detected by ultrasound. If serious defects that are not compatible with life are found, the question of terminating the pregnancy is raised. Artificial abortion is done for up to 12 weeks (up to 22 weeks - by special permission of the expert commission). The decision to terminate or continue the pregnancy remains with the woman.

Treatment Methods

Specific treatment during pregnancy is practically not carried out. Drugs active against CMV are prescribed only for strict indications when the infection is activated against the background of severe immunodeficiency. These funds are considered quite toxic and cannot be used uncontrollably in expectant mothers.

During pregnancy, interferon inducers (Viferon in the form of rectal suppositories) can be prescribed to stimulate immunity. Therapy is carried out for a period after 16 weeks. The course of treatment is 10-14 days. These funds increase the overall resistance of the body to infections and help protect the fetus from the aggressive effects of the virus.

With the reactivation of latent CMV infection during pregnancy, immunomodulatory therapy is performed. For this purpose, human immunoglobulin is used intravenously. The drug is administered three times during pregnancy in the I, II and III trimesters.

CMV infection is treated on an outpatient basis. Hospitalization is indicated only with generalization of the disease. According to the indications, related specialists (immunologist, etc.) are involved in therapy.

Evaluating the effectiveness of treatment for CMV infection is difficult. Specific antibodies (IgG) remain in a woman's body for life. It is important that the IgM level does not increase after the therapy. For control, serological diagnostic methods (ELISA) are used.

Prevention

Nonspecific prevention of CMV infection includes:

1. Compliance with the rules of personal hygiene.
2. Refusal of casual sexual relations.
3. Use of barrier contraceptives (condoms).
4. Increasing the overall resistance of the body to infections (rational nutrition, adequate physical activity).

It is recommended that all women planning pregnancy be screened for CMV. If an infection is detected in the active phase, it is necessary to consult a specialist. The course of treatment outside of pregnancy is 14-21 days. For the treatment of CMV infection, specific antiviral drugs (ganciclovir, acyclovir, etc.) are used.

An important point: in the blood of 90% of women of reproductive age, IgG to CMV is detected. This does not mean that all patients should be treated. The presence of specific antibodies indicates that the woman's body has developed protection against cytomegalovirus, and no therapy is needed in this case. The use of antiviral drugs is justified only with fresh infection, as well as with reactivation of one's own infection against the background of a decrease in immunity.

Many people know that CMVI is not always a dangerous disease, but when cytomegalovirus is detected during pregnancy, panic sets in. All because cytomegalovirus infection under certain circumstances can cause complications for the fetus, and subsequently for the child. Below we will consider what these circumstances are and what a woman needs to do during pregnancy in order to protect the unborn baby from cytomegalovirus infection as much as possible.

The vast majority of people do not have the necessary information about the actual presence of an infectious cytomegalovirus in their body. This herpetic virus does not openly reveal itself in any way, like other infections. Literally all the somatic signs of the disease are clearly felt by people with a deficiency of immunity - a special protection of the human body.

The maximum likelihood that children actually inherit CMV usually occurs when the mother becomes infected with cytomegalovirus during pregnancy. In the presence of antibodies to infection in the blood of a pregnant woman, the disease does not pose a significant danger to the unborn child.

But pregnant women are still at risk. Cytomegalovirus during pregnancy can be a serious danger in certain cases. To prevent the disease, it is necessary to know how the herpes virus is transmitted. Consider several causes of infection that pregnant women are often exposed to:

• The route of sexual transmission This is the main way of infectious infection of adults. The virus enters the human body both during traditional sexual contact without protective equipment, and during other sexual contacts, including anal or oral sex. Therefore, during pregnancy, you should ask your partner to check yourself for the presence of cytomegalovirus in the blood in order to avoid primary infection, if the pregnant woman has not yet had it.
• Weakened immunity which occurs due to frequent stressful situations, poor malnutrition, or due to frequent colds, which a woman is often exposed to during pregnancy.
• Close contact with an infected person- with a kiss through the mucous membranes of the lips and oral cavity. At the same time, during pregnancy it is also recommended to make sure that the partner is not infected with cytomegalovirus, or does not have a relapse of the disease.
• Household - with the general use of household items (cutlery, bed linen, towels, etc.).
• Blood transfusion- this is an extremely rare, but quite real phenomenon, which means getting an infection through donated blood or during organ transplantation from a virus carrier.
• Airborne- is transmitted by close contact with an infected person during sneezing or coughing, where during a conversation the virus enters the body of a healthy person.

CMV during pregnancy can easily be in the child's body both during the period of being in the mother's womb, and during childbirth or in the process of feeding with mother's breast milk.

The wide variety of CMVI transmission lines is due to the fact that the infection can simultaneously be in many areas of the body: in mother's milk or blood, saliva and urine, as well as in tears and secretions that are in the vagina.

Symptoms of cytomegalovirus infection during pregnancy

If a woman's immune system works well during pregnancy, then CMV usually does not detect itself by any external manifestation. The virus is always in dormant mode and is waiting for the immune system to lower its defenses. Having waited for this, the infection quickly makes itself felt.

Consider some of the symptoms of cytomegalovirus that may occur during pregnancy:

1. A rather rare main manifestation of the activity of cytomegalovirus infection, even during pregnancy, in people with absolutely normal immunity, is a mononucleosis-like syndrome. It is actively expressed by elevated body temperature, general malaise, immense headache. The syndrome appears approximately twenty days to two months after infection. The average duration of a mononucleosis-like syndrome can be from two to six weeks.
2. Often, with cytomegalovirus in women during pregnancy, signs appear that are very similar to SARS. As a result, many pregnant women mistake the infection for the common cold. The fact is that all the symptoms are almost the same: general malaise and weakness; runny nose and inflammation of the tonsils; with inflammation, an increase in the salivary glands; high body temperature. Cytomegalovirus differs from SARS in that the disease lasts longer - from four to seven weeks.
3. With a deficiency of immunity, cytomegalovirus during pregnancy can occur with severe complications. Usually, the consequences are with the occurrence of pneumonia or encephalitis, myocardium, pleurisy, and arthritis. In addition, vegetative-vascular affective disorders and even multiple lesions of various organs of the human internal systems are likely.

Very rarely there are generalized forms in which the infection actively spreads to the entire body of a pregnant woman:

• inflammation of the brain (most often leads to death);
• inflammation of internal organs (kidneys, adrenal glands, liver, spleen, and pancreas);
• paralysis (in rare severe cases);
• damage to the lungs, digestive system, and eyes.

So, it is worth emphasizing that this infection is found in the form of signs very similar to the symptoms of colds. All other listed symptoms appear very rarely, only when the immune system is in a very weakened state.

Diagnosis of CMVI and pregnancy

It is almost impossible to independently determine the possible presence of cytomegalovirus during the very planning of pregnancy. Of course, the virus, being in sleep mode, does not actively express itself in any way. With the activity characteristic of the virus, the infection can be easily confused with other diseases similar in somatic symptoms.

To confirm the presence of the virus in the blood, you must contact the clinic and conduct a differential diagnosis with specialists. After a visual examination of the patient by the attending physician, certain examinations are prescribed. The following complex special methods for diagnosing cytomegalovirus are planned:

1. Cytological medical examination of urine and saliva. Biomaterial (saliva and urine) is examined under a microscope. During pregnancy, cytomegalovirus infection is diagnosed by the actual presence of giant cells in the smear.
2. Polymerase chain reaction (PCR). Based on the exact determination of CMV DNA, which is an active carrier of the hereditary virus alert and is necessarily contained within it. For medical examination, scrapings and blood are used, as well as saliva, sputum and urine.
3. Serological studies of blood serum. The purpose of these studies is to detect antibodies. The most correct method - to determine the various types of immunoglobulins (IgM, IgG), enzyme immunoassay (ELISA) is examined.

Immunoglobulins M (IgM) are usually produced 28 to 49 days after infection. Their high degree decreases with the further formation of the immune response, while the number of immunoglobulins G (IgG) increases.

Immunoglobulins are proteins that are produced by blood cells. They are closely connected with pathogens, which, in turn, actively penetrate the human body and easily form a complex.

The persistent presence of IgG immunoglobulins indicates that the infection has occurred earlier and antibodies have already been developed. Timely detection of IgM immunoglobulins clearly confirms the primary introduction of the virus into the human body.

If there are no IgG and IgM immunoglobulins, then the expectant mother is automatically included in the risk group for primary infection due to the lack of antibodies in the body. In turn, this is fraught with possible consequences for the physical health of the fetus.

In children born to an infected mother in the first month and a half from the onset of birth, blood tests are examined for the likely presence of antibodies to IgG and IgM. If an IgG immunoglobulin was found in the blood of a child, then this is not a characteristic symptom of congenital cytomegaly. In stock IgM immunoglobulin confirms the acute stage of an infectious disease.

Methods of treatment of cytomegalovirus in pregnant women

Cytomegalovirus during pregnancy is an almost incomparable concept, especially during the first infectious infection. In some cases, there is a rather high risk of the possible manifestation of various somatic abnormalities in the development of the fetus. The risk of undesirable consequences for the fetus is much reduced if the expectant mother goes to the clinic in a timely manner for consultation and examination by specialists.

Treatment of cytomegalovirus infection in pregnant women, detected by laboratory tests, is mandatory if a latent viral disease is reactivated. And also with primary infectious infection in acute form.

Unfortunately, modern medical science has not yet developed drugs that can destroy cytomegalovirus in the human body forever. Therefore, the goal of treatment is to eliminate somatic symptoms and fix the virus in a passive (inactive) state.

Medications

With cytomegalovirus during pregnancy, it is advisable to use antiviral drugs and immunotherapy. In the first, second and third trimester, 3 courses of immunoglobulin treatment are carried out (a special cell found in human blood that supports its immunity).

1. Immunoglobulin Neocytotec - solution. immunological drug. For the prevention of CMVI in patients with a drug-suppressed immune system. Therapy of CMVI in patients with a weakened immune system, in particular, premature babies or newborns. Prevention of disease manifestation after CMV infection.
2. Immunomodulators. Viferon - suppositories, ointment or gel - from the group of interferons (drug with antiviral effects). Kipferon, suppositories - a combination of immunoglobulin and interferon (used in the treatment of viral etiology and acute viral cause of the disease). Wobenzym, tablets - a combined enzyme (antimicrobial, anti-inflammatory, antiviral, immunomodulatory, analgesic with anti-edematous properties).
3. Antiviral. Valaciclovir - tablets (prevention and treatment of CMVI, analogues - Valcicon, Valvir, Valtrex, Valciclovir Canon).

vitamins

Currently, it is not always possible for pregnant women to eat properly and regularly. Just by the way, there will be a comprehensive support for the body with vitamins. They compensate for the lack of certain micro and macro elements in the mother's body, from which the fetus takes resources for healthy development.

Consider some of the most worthwhile vitamins for pregnant women:

1. During the first trimester. Vitamin A - prevention of disorders of the nervous system; vitamin C - boosting the immune system, the body's fight against viruses and infections; iodine - for the proper creation of the fetal nervous system; vitamin E - for the proper creation of the placenta.
2. During the second trimester. Iron - to reduce the risk of anemia; iodine - when creating the skeleton of the fetus and the formation of mental abilities; calcium - takes part in the creation of the endocrine system and kidneys.
3. During the third trimester. Vitamin C - improves the functioning of the immune system; magnesium - for the prevention of premature birth; vitamin D - for the prevention of rickets, for the proper formation of the skeleton.

So, summing up, it is worth noting that cytomegalovirus is not always dangerous even during pregnancy. But everything should be done to protect yourself from the possible manifestation of cytomegalovirus infection. And if the pregnant woman has not yet met with the virus, then it is necessary to protect herself from all potential carriers until the child is born. And also if you have already passed the tests and want to decipher them, we advise you to read the article -

Cytomegalovirus, abbreviated as one of the varieties of herpes. According to statistics, more than half of people regardless of age and gender are infected with this virus.

Most people know what it is and whether the infection is in the body. It is especially important to know about the presence during pregnancy, since CMV can affect the development of the fetus and is transmitted from mother to child.

Disease through direct contact with a person during an exacerbation of the disease. You can get infected if you share common dishes, hygiene products, kiss, have sex. During pregnancy, the virus is transmitted through the placenta, secretions, blood during childbirth or breastfeeding after birth.

Features of the clinical picture

There is the concept of congenital and acquired cytomegalovirus. In the first case, the disease often does not manifest itself. If the virus is acquired, a person may face a number of problems. When it first enters the body, it remains there for life and can be activated with a general deterioration in health.

The complexity of the disease is the absence of clinical symptoms. Only a few feel something similar to the symptoms of the flu or mononucleosis:

• temperature;
• cough;
• chills;
• fast fatiguability;
• muscle pain.

It can even skip cytomegalovirus. It is possible to make a correct diagnosis only after receiving the results of the tests.

In the first trimester, infection is most dangerous. The virus can be overlooked. In the meantime, it crosses the placenta into the baby's body and can cause death.

In early pregnancy, the mother's body is able to suppress the activation of the virus. But over time, it becomes stronger and at a later date leads to infection of the fetus. That is why it is recommended to take it three times: during the planning period for conception, in the second and third trimester.

Effect of cytomegalovirus infection on fetal development

Infection in early pregnancy can cause miscarriage or fetal abnormalities. In the third trimester, there is a risk of premature birth, polyhydramnios, the occurrence of "congenital cytomegaly".

- an infectious disease, the result of intrauterine infection with cytomegalovirus. CMV carries for the fetus: it affects the internal organs of the child, the brain, causes pathologies of vision and hearing.

If it was in the mother's body before pregnancy, the chance of passing it on to the child is very small (1%). A higher risk of affecting the health of the baby is to become infected while already pregnant (40-50% probability). During this period, the virus easily enters the fetus through the placenta and begins to destroy internal organs and affect the nervous system.

There are three forms of CMV depending on the symptoms and the degree of damage to the internal organs of the child:

1. Light form- there are practically no symptoms and damage to the body.
2. Middle form suggests organ dysfunction.
3. Severe form- pronounced symptoms and disorders, often leading to death.

The virus can cause the activity of antiphospholipids in the body of a pregnant woman, which will cause auto-aggression. This is an attack on the cells of the body, causing disturbances in the uteroplacental blood flow.

Consequences for a child born to a mother with CMV

Infection of a child can lead to malformations of internal organs of varying degrees of complexity (dropsy, jaundice, heart disease, hearing loss, mental retardation, etc.), low birth weight, or intrauterine death.

In 90% of cases, CMV is in a "silent" stage, without causing any problems. For most, the infection remains, without showing itself. In 5-15% of babies, problems start much later.

In adulthood, infection with the virus often causes hearing loss. Another 10-15% face complications in the functioning of the nervous system, growth retardation, enlarged internal organs. The rest face more serious complications, many of which are incurable.

Features of the diagnosis of the virus in pregnant women

The disease often goes unnoticed, as a simple examination is not able to detect it. For verification, an analysis for TORCH infection is required. Diagnosis is carried out using three methods:

• polymerase chain reaction;
• cytology of urine and saliva;
• serum serology.

IgM "positive" means that the body is infected and the virus enters the active stage. In this case, pregnancy is undesirable. The value "negative" indicates the presence of the virus, but the infection occurred for a month or more, so the risk of intrauterine transmission of the infection to the child is low.

The presence of IgG in the results can indicate both a “quiet” state of infection and an active phase of the disease. If the immunoglobulin of this type is within the boundary values, the virus is not detected in the body.

An IgG level below the values ​​indicated on the sheet indicates the absence of the virus. On the one hand, this is a good result, on the other hand, such women are at risk, as they can become infected during the period of bearing a child.

positive analysis

IgG "positive" indicates the presence of immunity to CMV. Such results indicate that a person is a carrier of the virus. If a woman is pregnant, this poses a threat to the child, since the small body does not yet have the necessary immune defenses to resist cytomegalovirus.

Dubious analysis

If the analysis results show a low amount of antibodies, it is classified as “doubtful”. In this case, the woman is sent for analysis by polymerase chain reaction (PCR).

Carrying CMV

A carrier of cytomegalovirus infection is a person in whose body the virus is present, but in a passive stage. It does not manifest itself in any way, so the patient does not suspect its presence in the body. After testing, it is very difficult to distinguish the carrier from the latent course of the disease. The difference can be noticeable by indirect signs. The latent state of the virus is characterized by symptoms: frequent fatigue, inflammation of the cervix, the presence of subfebrile body temperature (37.1-38 ° C).

Features of treatment

It is impossible to completely get rid of the virus. Only symptomatic treatment is possible. His program is centered around eliminating symptoms, passing the infection to a passive state, and preventing complications that threaten the child.

Pregnant women are prescribed drugs aimed at general strengthening of immunity, herbal preparations. During the active stage, they are additionally used. differs depending on the trimester, repeated tests should be taken every four weeks.

With cytomegalovirus infection, the doctor prescribes for several weeks.

Immunoglobulin is administered intravenously or intramuscularly. Doctors still recommend using a dropper, as there is a more effective response. In some cases, non-specific immunoglobulins are used as a prophylactic.

The list of drugs used during the treatment of CMV can only be prescribed by a doctor. Antiviral drugs are quite toxic. Only a specialist is able to determine a safe dose for a child, which at the same time will help to cope with the virus.

Self-medication of cytomegalovirus is prohibited. Complex therapy allows you to quickly remove the virus from the blood, saliva, breast milk of the mother, transferring it to the passive stage.

The main groups of drugs

To treat cytomegalovirus infection, doctors use interferons and antiviral drugs. Each of them is aimed at solving a specific problem. Antivirals block the reproduction of the virus in the body, immunoglobulin - destroys its particles - protects cells from the effects of the virus.

They also use general immunomodulators to strengthen the body and special medicines to restore damaged organs. Topical medications may be given to relieve symptoms.

Effect of treatment on the fetus

The main task of the treatment process during pregnancy is to exclude possible complications, to avoid possible destructive effects of the virus on the fetus. The drugs that are used for this do not affect the condition of the baby, so the treatment is considered safe. It is important to take repeated tests in a timely manner and not forget about preventive measures.

General strengthening of the body, exercise, personal hygiene and caution in interacting with other people can protect infections or avoid the transition of the disease to the active stage.