Do they take on eco with cytomegalovirus. Cytological examination of the cervix

2016-05-06 18:01:09

Irina asks:

Good afternoon. Please advise the following:
my husband and I are applying for free eco, I passed the torch infection:
toxoplasma lgG 450 with a reference value of 30.0 or more;
toxoplasma lgM 0.23 with a reference value of 0.8 or less
rubella lgG > 500 with a reference value of 10.0 or more;
rubella lgM 0.8 with a reference value of 0.8 to 1.0 doubtful result, less than 0.8 negative result;
cytomegalovirus lgG 257 with a reference value of 1.0 or more - a positive result;
cytomegalovirus lgM 0.449 with less than 0.7 negative result;
herpes type 1 lgG 3.7 with more than 1.1 positive result;
herpes type 1 lgM 0.22 with less than 0.8 negative result;
herpes 2nd type lgG 0.2 with less than 0.9 negative result;
herpes type 2 lgM 0.33 with less than 0.8 negative result.
The gynecologist through whom we submit the documents says that it is very bad that high titers of lgG and they will not be allowed to pass on the commission for eco. I retaken after 2 months the values are exactly the same as the previous ones. There was a consultation with an infectious disease specialist, who said that these titers mean good immunity to these infections and there is nothing wrong with that, and does not require treatment. But the gynecologist insists on treatment (previously Nuclex).
Q: Is treatment required? and why such high credits of lgG can keep? and rubella 0.8 lgM at a rate of up to 0.8 can mean that I have this infection?
Thanks in advance for your reply!

Responsible Yanchenko Vitaly Igorevich:

Irina, hello! Retake rubella IgG and IgM in dynamics 2 weeks after the first donation. If there is no growth of M antibodies, but rather a fall, then there is no need to worry. In all other respects, I completely agree with the infectious disease specialist.

2015-10-21 12:30:57

Hope asks:

Good afternoon!
In a month we plan to do IVF. All analyzes are good. Confuses only Cytomegalovirus. In 2013, I took tests for him. IgG 98 (normal - 15) IgM 0.61 (normal - 1)

Now before IVF the results are as follows
08/10/2015 IgM 0.9 (1.0 - antibodies detected) IgG did not pass

10/14/2015 IgM 0.9 (1.0 - antibodies detected) IgG 101.6 ++

20/10/2015 IgM 0.8 (1.0 - antibodies detected) IgG95.1 ++

Tell me, please, does this also mean that the active phase of the virus has passed and you can do IVF, or is it still worth postponing the procedure (which is not desirable for me in many ways)?

Thanks in advance!

Responsible Medical consultant of the portal "site":

Hello Hope! The results indicate that the cytomegalovirus is inactive and there is no reason to postpone IVF. Good luck. Take care of your health!

2015-10-14 09:53:35

Irina asks:

Good afternoon, in order to enter the IVF program, I did an examination for IUI: herpes type 1 IgG norm> 1.10 result 2.45 positive
Cytomegalovirus IgG normal >1.10 result 7.50 positive
Rubella IgG norm 10.00 result 198.00 positive, what does this mean, and is it possible to do IVF with such results?

2015-05-13 16:18:30

Nick asks:

Good afternoon! I am 30 years old, I am undergoing an examination before IVF. I passed tests for TORCH infection, antibodies were found Toxoplasma gondii IgG 223.4 MO \ ml, Rubella virus IgG 102.1, Cytomegalovirus (CMV) IgG 374.7, Herpes simplex virus (HSV) type 1 IgG>8. Is it necessary to carry out treatment, and how can this affect conception? Thank you

Responsible Serpeninova Irina Viktorovna:

It is necessary to pass immunoglobulins M (markers of an acute inflammatory process that can affect the fetus) and make IgG control. Treatment is necessary when immunoglobulins M are detected and the IgG titer increases by more than 2 times.

2015-03-03 10:06:14

Tanya asks:

Hello! I'm getting ready for eco. The results of the tests for 2012. Can these tests affect gestation, conception? Is it worth retaking?
to cytomegalovirus: IgG antibodies 239.7 units / ml (more than 1.0 positive); IgM antibodies 0.2 (index up to 0.7);
to the rubella virus: IgG antibodies > 500 IU / ml (more than or exactly 10.0 - a positive result); IgM 0.31 (less than 0.8 - a negative result);
to the herpes virus type 2: IgM antibodies 1.3 (more than 1.1-positive). IgG antibodies 10 units / ml (less or exactly 16-negative);
to toxoplasma gondil: IgG antibodies less than 0.13 IU / ml (less than 1.0-negative result); IgM antibodies 0.08 (less than 0.8-negative result).
please decipher my tests. do they affect conception and pregnancy? thanks

Responsible Bosyak Yulia Vasilievna:

Hello, Tatyana! The presence of Ig G indicates contact with infections in the past, is not subject to treatment and indicates developed immunity. Ig M characterize acute infection, if after 2 weeks the titer increases by 4 or more times. According to the results, everything is in order, although at the IVF planning stage you will retake the analysis for torch infection.

2014-07-03 18:30:18

Mary asks:

Good afternoon! Please answer my question. I am planning a pregnancy with an IVF procedure. I tested for the herpes virus (because there are relapses 2-3 times a year). over 1.1 - positive. Cytomegalovirus Lg M - 1.1 coefficient positive, with a laboratory norm > 1.1 positive. .For the second month, valavir with proteflazidom. I read about ALVIRON that it is used for hepatitis. What does it have to do with herpes?

Responsible Palyga Igor Evgenievich:

Hello Maria! I would, of course, have acted somewhat differently. I would advise you to retake the analysis for Ig M in 2 weeks, and if the titers increased by 4 or more times, then he would prescribe treatment. You understand that it is impossible to completely recover from herpes, you can only achieve a stable remission when planning a pregnancy. After the onset of pregnancy, there is a physiological drop in immunity, so herpes, treated or not, can worsen. The indicator for CMV is generally the upper limit of the norm. I am not an infectious disease specialist, but I am somewhat skeptical about the exogenous administration of interferons. Alviron is just an interferon preparation and is used for many pathologies of viral origin (not only for hepatitis)

2014-05-20 18:53:41

Julia asks:

Hello. I am planning IVF.
Found out while preparing
infection with cytomegalovirus.
Test results:
At CMV IgM- 3.268 (unit - KP)
At CMV IgG- 14.937
At CMV IEA IgM- 0.264
At CMV IEA IgG- 5.160
CMV IgG-avidity - 98%
CMV DNA was not found in blood, urine, saliva. PCR (CMV/HHV-5) was not detected.
Do I need to undergo treatment before pregnancy, given the positive
CMV IgM results?
Thank you.

Responsible Palyga Igor Evgenievich:

I advise you to retake the analysis for At CMV IgM in 2 weeks. With an increase in titer by 4 or more times, we can talk about acute infection and the need for treatment. Today I do not find anything critical in your analyzes, I am almost sure that you do not have CMV and you can plan an IVF program.

2014-04-25 16:45:40

Nata asks:

Good evening!
We are planning IVF, my husband and I passed tests for antibodies, the results of my husband:

-CMV (Cytomegalovirus) IgG (antibodies) - positive.

My result:
-Herpes simplex IgG (antibodies) - positive;
-CMV (Cytomegalovirus) IgG (antibodies) - positive;
- Toxoplasma gondii IgG (antibodies) - 162.14 IU / ml;
-anti-Rubella IgG (antibodies to the rubella virus) - 200.0

IgM - negative in all respects for my husband and for me.
Please explain to us how a positive result can harm and how, with what, what medicines to treat in order to become negative.
I have the last chance to get pregnant, I have repeatedly done replanting with such results and everything is for nothing: (What to do ????? I went to the doctor today, but she ignored it: (((((

THANKS!

Responsible Purpura Roksolana Yosipovna:

Believe me, torch infections have nothing to do with embryo implantation. Your and your husband's tests are normal. IgG indicate contact with the infection in the past and are not subject to treatment at any values. The fact that there are antibodies to rubella is wonderful, it means that you have developed immunity. The reason for IVF failures must be sought elsewhere, perhaps the problem with getting into the "implantation window" or the state of the endometrium, if the embryos are of good quality. If you did not undergo hysteroscopy before the IVF protocol, then this must be done.

Cytomegalovirus infection (CMVI) is transmitted sexually, through saliva, common hygiene items (towel, soap), dishes. Nursing mothers pass the infection to their children through breast milk. A pregnant woman infects the fetus with an infection. Treatment of cytomegalovirus in women prevents its development and spread.

Previously, the disease was called "kissing", as it was believed that it was transmitted through saliva. With the development of medicine, it became clear that the infection is transmitted not only in this way. It is found in blood, urine, feces, semen, cervical mucus, and breast milk. The infection is also transmitted through blood transfusions and organ transplants.

Almost 100% of people are carriers of the infection at the end of their lives. Statistics show that by the year every fifth inhabitant of the planet is a carrier of cytomegalovirus. By the age of 35, more than 40% acquire an infection, and by 50, all 90%. These data make the infection the most common on the planet.

Cytomegalovirus in most cases is a passive infection that manifests itself when the immune system is weakened. The cause of the disease is the Cetomegalovirus hominis virus, a "relative" of herpes.

The virus does not have clear symptoms, prefers to live in favorable conditions and carefully selects the cells where it will multiply. When immunity is weakened, the infection infects cells, prevents their division, which causes them to swell.

Cytomegalovirus is not treatable. It can be deactivated with the help of immunomodulators and anti-inflammatory drugs. The infection is most dangerous during the period of conception, gestation and breastfeeding, as it causes fetal developmental disorders.

Cytomegalovirus is firmly fixed in the cells and never leaves them. This does not mean that a person will constantly get sick. On the contrary, the infection does not manifest itself in most carriers. The immune system protects the body from the activity of the virus.

For the development of the disease, a significant weakening of the immune system is needed. An infection can use any situation to start, up to beriberi, but most often it is waiting for something strong and unusual. For example, AIDS or the impact on the body of specific medications that destroy oncological pathologies.

Localization and symptoms:

runny nose with damage to the nasal passages;
constipation and weakness in case of damage to internal organs;
inflammation in lesions of the urinary organs (inflammation of the uterus, cervix or vagina).

What diseases does CMV cause?

Cytomegalovirus can present as an acute respiratory infection. A person complains of weakness, fatigue, headaches, runny nose, profuse salivation. Plaque appears on the gums and tongue, mucous membranes become inflamed.

The infection can affect internal organs. At the same time, inflammation of the tissues of the liver, spleen, kidneys, adrenal glands, and pancreas is diagnosed. Against this background, bronchitis or pneumonia of unknown origin develops, which do not respond to antibiotics. CMV affects the brain and nerves, intestinal walls, and eye vessels. Inflamed salivary glands, blood vessels. A rash may appear.

When the genitourinary organs are affected, women are diagnosed with inflammation of the uterus, cervix or vagina. In men, infections are practically not manifested in any way.

Diagnosis of CMV

It is impossible to independently identify cytomegalovirus. Its symptoms are unclear and often similar to acute respiratory infections (runny nose, high fever, sore throat, swollen lymph nodes). Most often, the infection accumulates in the salivary glands, where it is convenient, so the only symptom may be their inflammation. In rare cases, an enlarged liver and spleen are diagnosed.

The only difference between cytomegalovirus and banal acute respiratory infections is the duration of the course of the disease. The impact of the first lasts 30-45 days.

A dermatovenereologist is engaged in the diagnosis of cytomegalovirus. The virus is examined using DNA diagnostics - polymerase chain reaction (PCR). Under a microscope, saliva, blood, semen, cervical mucus are studied. During pregnancy, amniotic fluid is analyzed. A sign of the virus is the abnormal size of the cells.

Cytomegalovirus can be detected using an immune study (monitoring the reaction of the immune system). An analysis for this virus is desirable for women who are planning a pregnancy.

Diagnosis of CMV in pregnant women

When cytomegalovirus cells enter the body, the immune system begins to produce antibodies that prevent the active effects of the infection. Thus, the disease goes into a latent phase.

To identify an infection in a pregnant woman, a blood test is performed for specific IgM and IgG immunoglobulins. IgM antibodies can accurately indicate the presence or absence of the virus, and IgG indicate an exacerbation of the infection only at high rates.

IgM antibodies indicate a primary or recurrent form of cytomegalovirus. If the result is positive, we can talk about the presence of a primary infection or the transition of the virus from an inactive phase to a painful one. With test results with positive IgM, pregnancy cannot be planned, because the risk of transmitting the virus to the child is high.

In this case, the level of antibodies is checked every 2 weeks, which allows you to determine at what stage the infection is. With a sharp drop in the number of IgM antibodies, there is a recent infection or exacerbation. In the case of a slow decline, the inactive phase is diagnosed.

If IgM is negative, infection has occurred more than 30 days before the test, but the transition to the active phase is still possible. If the result is negative, infection of the fetus is rare.

IgG immunoglobulin values can indicate latent virus, exacerbation and primary infection. It all depends on its quantitative indicators. Increased values indicate the presence of a virus. In this case, the probability of infection of the fetus cannot be determined.

With a normal IgG value, we can talk about the absence of the virus or that the infection occurred more than 90-120 days before the test was taken. With such indicators, infection of the fetus does not occur. The exception is the simultaneous detection of IgG and IgM antibodies.

In the absence of infection, the amount of IgG will be below normal. Despite the absence of a dangerous cytomegalovirus, it is women with this indicator who are at risk. They can become infected during pregnancy.

After infection with cytomegalovirus, IgG indicators are constantly detected in the blood. Against the background of pregnancy, a transition from the latent phase to the painful one is possible, even with IgG indicators. After infection and transition to the active phase, the indicators increase by 4 times or more (compared to the initial figures) and slowly fall.

CMV in a smear in a pregnant woman and other tests

A pregnant woman needs to be tested for TORCH infections (rubella, herpes, CMV, toxoplasmosis, and others). Examination is not necessary, but helps to avoid consequences. The results of these tests will help you understand the dangers and risks of pregnancy. If the result is positive, you should be tested in another laboratory.

If CMV is detected in a smear at a later date, you need to carefully monitor the health of the expectant mother. Proper behavior helps to avoid problems with the development of the child. It is necessary to strengthen the immune system and eat right. Immunomodulators and antiviral agents are prescribed.

If CMV is detected in a smear in the first 12-13 weeks of pregnancy, pathologies cannot be avoided.

Primary infection during pregnancy occurs in 1-4% of cases. Reactivation (repeated acute form) occurs in 13% of pregnant women. Secondary infection with other strains of CMV is also possible. There are 3 registered in total.

Primary infection with cytomegalovirus during pregnancy is extremely dangerous. When the virus first enters the body, there are no antibodies in the blood, which allows it to easily penetrate the fetus through the placenta. With primary infection from a person with an acute exacerbation, infection of the fetus occurs in 50% of cases.

Another thing is if the pregnant woman became a carrier long before conception. In this case, in the absence of an exacerbation, the virus is rarely transmitted to the child. The fact is that with an exacerbation of the virus, antibodies in the mother's blood are already present and come into the fight against the pest. During the struggle, the cytomegalovirus weakens and cannot break through the placenta. In this case, the risk of infection of the fetus is 1-2%.

It is important at what period of pregnancy the infection or exacerbation occurred. In the first trimester, the virus can contribute to miscarriage and abnormal fetal development. In the second trimester, the danger is not so likely, and in the third, defects are not diagnosed. However, late exacerbation of the virus is dangerous with polyhydramnios and, as a result, premature birth and congenital cytomegaly.

Congenital cytomegaly in a newborn

The condition is characterized by the presence of jaundice, anemia, enlargement of organs (liver and spleen), pathology of vision and hearing, blood changes, and serious disorders of the nervous system can be diagnosed.

A blood test will help confirm the presence of the virus. If IgM antibodies are detected, we can talk about acute cytomegalovirus infection. When detecting IgG antibodies, it is impossible to say for sure, because they could be transmitted to the child from the carrier mother. If after three months they disappear, then there is no infection.

Symptoms of cytomegalovirus in a pregnant woman

In the expectant mother, the infection manifests itself as the flu. There are signs of high temperature, weakness, inflammation of the mucous membranes, runny nose. The picture looks like a respiratory infection, which usually does not go to the doctor.

The likelihood of fetal infection

The probability of infecting the fetus depends on the concentration of cytomegalovirus in the blood. Those who are first infected are most likely to transmit the infection. Antibodies have not yet developed, so the concentration of the virus is high. Carriers have a lower concentration. Prevention is the protection of the pregnant woman and the newborn from patients with an acute phase.

Treatment regimen for cytomegalovirus

Cytomegalovirus is incurable. However, with sufficiently strong protection of the immune system and under the influence of certain antiviral drugs, it does not manifest itself.

Immunity is not formed against cytomegalovirus, therefore, with a weak immune system, medications must be taken. Three-month regimen for the treatment of cytomegalovirus:

1 week - decaris (levamisole);
a break of 2 days;
2 weeks and the next - decaris according to the reverse scheme (only 2 days);
a break of 5 days.

In total, 2950 g of decaris is obtained in 3 months. If the drug is ineffective, the course may include T-activin, thymotropin, reaferon. It is also possible to use gamma globulin with high levels of anticytomegalovirus.

Popular drugs

In the treatment of CMV, drugs that are effective in herpes are used. However, it is impossible to delay the course of treatment with such drugs due to their toxicity. Ganciclovir is rarely used. the drug is expensive. However, it is effective in CMV in newborns, it can reduce the chances of death, weaken the effects of pneumonia and thrombocytopenia, mitigate nervous pathologies, and avoid abnormal development of the eyes and auditory nerves.

Virazole, ganciclovir and vidarabine are not used because they do not give a strong effect. Foscarnet, guanosine analogues and cymevene are not prescribed for newborns. In adults, these drugs can inhibit CMV and prevent its synthesis in cells.

Pregnant and lactating women are prescribed a full range of drugs to strengthen the immune system and drugs that suppress the virus (interferon). However, anti-CMV therapy for pregnant women and neonates has not been improved. Most often, symptomatic therapy and prevention are carried out.

In women with a burdened history (the presence of abortions and serious diseases of the genital organs), treatment is carried out with the help of immune-correcting agents.

Treatment of cytomegalovirus during pregnancy comes down to personal hygiene, heat treatment of food and drug therapy. A woman should consult a gynecologist and a virologist.

Hospitalization of pregnant women with CMV occurs 14 days before delivery. Infected newborns are isolated from the mother and other children. When breastfeeding, you must follow the rules of hygiene. It is necessary to carry out thorough disinfection of the ward and linen, sterilize instruments. The child is examined daily by a doctor. On days 2, 5 and 12, scrapings are taken from the mucous membranes of the eyes, mouth and nose for analysis.

It is possible to terminate pregnancy with an acute form of cytomegalovirus.

IVF with cytomegalovirus

Before artificial insemination, a woman must be tested for CMV. No doctor will issue a permit for fertilization with a confirmed cytomegalovirus. A woman must undergo a course of treatment before qualifying for IVF.

Infertility due to cytomegalovirus

Cytomegalovirus and herpes can cause infertility. These viruses are present in the body of almost every person, but become dangerous only under certain circumstances. The effect of cytomegalovirus and herpes virus on reproductive function has not been practically studied.

By itself, CMV is not the cause of infertility, but causes diseases that lead to it. According to studies, CMV and HHV-6 are found in the semen of most infertile men. These viruses provoke inflammation of the urinary organs, chronic inflammation,. Cytomegalovirus predominates in men with urinary tract inflammation. The virus is also able to penetrate into germ cells.

Cytomegalovirus can interfere with the natural conception of a child, as well as artificial insemination.

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Almost all viral infections, if they are not detected in time and treated incorrectly, can provoke a pathology of fetal development, as well as complicate the course of pregnancy. Cytomegalovirus, unfortunately, is no exception.

During the planning of pregnancy, it is recommended for everyone, without exception, to conduct a study to detect cytomegalovirus infection. If it is found in a woman who plans to give birth to a child, therapy, as well as doctor's prescriptions, will depend on the stage of the infection process. As a rule, in any case, specialists prescribe the most sparing course of treatment.

There are no critical recommendations regarding pregnancy planning for a woman who is a carrier of CMV. A significant and potential threat to the baby will be only if the mother became infected with the virus for the first time at the time of gestation. Or the disease has sharply intensified after being in a latent state.

Cytomegalovirus and IVF, do they take it with CMV?

Cytomegalovirus when planning a pregnancy is not at all a reason to refuse IVF. In most cases, this medical procedure is carried out. But, as a rule, after a preliminary course of treatment. During which, the patient takes drugs that suppress the virus. In addition, several dosage forms are prescribed that help strengthen immunity.

Cytomegalovirus and IVF, according to most experts, the concepts are quite compatible. After all, it is impossible to completely recover and get rid of the virus. You can only suppress it. Therefore, the diagnosis is not a taboo for planning IVF for CMV.

Can you get pregnant with cytomegalovirus (CMV)?

On the factor of future conception, CMV has not a direct, but a mediocre effect. In particular, it causes a significant decrease in immunity, provokes frequent respiratory diseases. In addition, it often provokes inflammatory processes, including chronic ones, of the genitourinary system, which can lead to the formation of adhesions that will hinder attempts to get pregnant.

When planning pregnancy, women are offered to be tested for infections that can cause fetal developmental pathologies, one of them is cytomegalovirus infection (CMV). Infection of the embryo with cytomegalovirus can lead to fetal death, or the birth of a sick child.

CMV infection

Infection with cytomegalovirus occurs through contact with a sick person; once infected, it is impossible to completely get rid of the infection. But a healthy person develops immunity against CMV, with the help of which the activity of the virus is restrained.

Diagnosis of CMV

Detect the presence of infection in the body by determining the immunoglobulins to the virus in the blood by ELISA. To determine the risk for a child, it is enough to determine the concentration of IgG, which provides immunity against the virus and IgM; its detection in the blood indicates the active phase of the disease. 7-8 weeks after infection, IgM is no longer detected in the blood, indicating that the body has developed immunity against the virus.

CMV during pregnancy

The danger to the fetus can be the active phase of an infectious disease, at which time the probability of infection of the fetus is 45-50%. Therefore, if a woman has never been infected with this virus, and this is evidenced by negative IgG and IgM, then her main task is to avoid infection during pregnancy.

When only IgG is detected in the blood, this indicates immunity to CMV, in such cases the probability of infection of the fetus is less than 1%. This is what reproductive specialists are guided by when preparing women for IVF.

When can IVF be done?

Active CMV and IVF are incompatible, despite the fact that CMV is not transmitted directly to the embryo during IVF, pregnancy can only be planned 6-7 months after infection, when IgM completely disappears in the blood and only IgG remains.

To determine when an infection occurred, an indicator such as avidity is used. If the IgG avidity is more than 60%, then the infection was more than 5 months ago, which means that you can already plan a pregnancy and do IVF.

Thus, in vitro fertilization is carried out if:

IgG negative and IgM negative, but the woman is warned to be careful not to contract CMV, as CMP is transmitted sexually and by kissing;
IgG positive and IgM negative, indicating immunity to CMP.

If IgM is detected, it is required to be re-examined and postpone pregnancy planning, IVF for several months until normal immunity to this virus develops.

Cytomegalovirus, unfortunately, is no exception.

Cytomegalovirus and IVF, do they take it with CMV?

Can you get pregnant with cytomegalovirus (CMV)?

Can cytomegalovirus be dangerous during pregnancy

The combination of pregnancy and cytomegalovirus infection for many expectant mothers is a truly frightening tandem. Many have heard about children suffering from deafness and epilepsy from birth, and therefore, for pregnant women, reliable information about the cytomegalovirus itself and its effect on fetal development is very much in demand.

And first of all, it should be said that the bearing of a child and cytomegalovirus are quite compatible concepts, and in the vast majority of cases their combination does not pose a danger to the fetus. This is evidenced by both statistics and dry theory. And all the horrors with which future mothers scare each other are connected only with the tradition that has developed in the post-Soviet space, blaming cytomegalovirus for many troubles in newborns. It comes to the point that even the presence of immunity to this virus is sometimes declared the cause of abnormalities in the development of the fetus (!).

In order to better understand what is at stake when a doctor interprets a particular test result, you should understand the theory a bit.

The behavior of the virus in the body of a pregnant woman: a little theory

Cytomegalovirus (CMV) easily infects people who do not have specific defenses against it. Due to its extreme prevalence (it is believed that more than 90% of the world's population is infected with cytomegalovirus), most children over the age of 1 year already have time to get acquainted with the virus.

The important thing is that CMV remains in the body forever after infection. But there is nothing terrible in this: the immune forces of the body will successfully prevent any attempts of the virus to become more active, and new viral particles that enter the body will be instantly destroyed.

Also, those lucky adults who managed not to get infected in childhood almost always manage to catch CMV infection in the first half of life. In the vast majority of cases, the primary exacerbation is either asymptomatic or resembles a sore throat, and does not leave behind any complications. But during this time, the infected person develops a strong immunity that will protect the body from infection for life.

Therefore, if a pregnant woman has already become infected with cytomegalovirus before pregnancy, then almost nothing threatens her or the fetus: the antibodies produced by the body will protect the fetus as reliably as any other tissue.

Only in exceptional cases in immunocompetent mothers can infection of the fetus with cytomegalovirus occur. This can happen with a relapse of the disease caused by a decrease in immunity. But this is not an unequivocal reason to panic.

Really dangerous is the situation in which the first infection in life falls precisely on the period of pregnancy. It is in this case that various lesions of the fetus with the virus occur, which differ depending on at what stage of pregnancy the infection occurred.

But here, too, the statistics are merciful: only 40% of women who first become infected with CMV infection also experience fetal damage. In the remaining 60%, the virus has no effect on the fetus. And whether infection will occur at all and what it will be depends on several factors ...

Possible situations during primary infection

So, in the practice of monitoring and treating pregnant women, there are three situations associated with infection with cytomegalovirus, which are characterized by different consequences.

1. Situation one: even before pregnancy, a woman's blood test showed that she had antibodies to the virus.

Such women are also called seropositive, and the result of the analysis can be formulated as "cytomegalovirus: IgG positive."

In fact, this situation means that the woman had been ill before pregnancy due to infection with CMV infection and currently has reliable immunity to it.

The only risk to the fetus is that if a woman’s immunity is accidentally reduced, the virus may reactivate in her body. However, cases of such reactivation are quite rare, and even with it, the fetus is rarely affected. According to statistics, the probability of fetal damage in case of recurrence of CMV infection is 0.1% (once per thousand episodes).

In such a situation, it is problematic to identify the very fact of relapse - it rarely manifests itself as any symptoms. And to insure, conduct an ultrasound examination of the fetus and take constant tests to detect a virus in him is extremely irrational.

2. Situation two: antibodies to cytomegalovirus are detected only during pregnancy, while before this study was not carried out.

To put it simply, the woman has never had a blood test for CMV, and it was only during pregnancy that the corresponding antibodies were detected.

Here it is no longer possible to unambiguously say whether these antibodies were present in the body earlier, or appeared during infection during pregnancy. Therefore, for a more accurate interpretation of the research results, an additional analysis for the avidity of antibodies is given.

Avidity is the ability of antibodies to attach to a viral particle in order to destroy it. The higher it is, the more likely it is that the primary infection occurred earlier than 3 months ago.

Therefore, if in the first 12 weeks of pregnancy, the results of additional analysis indicate a high avidity of antibodies, infection occurred before pregnancy, and infection of the fetus with the virus will almost certainly not occur.

If the analysis showed high avidity of antibodies after the twelfth week, ambiguity arises again. After all, a situation could well have occurred when the infection occurred in the first days of pregnancy, and by the thirteenth week, immunity had reached its highest strength. However, the defeat of the fetus in this case most likely occurred at the earliest stage of its development, which is often fraught with serious consequences.

In general, when analyzing the results for cytomegalovirus after the 12th week of pregnancy, they cannot be absolutely accurately interpreted. However, it is possible to conduct an additional study on the presence of the virus in the amniotic fluid or to identify the presence of specific IgM to it. The first analysis will indicate whether the fetus was affected, the second will help to understand when the infection of the mother's body occurred.

3. Situation three: the woman does not have antibodies to cytomegalovirus.

This situation is the rarest. Such women are also called seronegative, since the analysis for IgG to cytomegalovirus in them gives a negative result. That is, they have no immunity to this virus.

Women in this group are most at risk: they can become infected at any time, and the infection can affect the developing child. The risk of infection of the fetus in this case is approximately 40%, and the appearance of developmental disorders in it is about 9%.

It is important to understand that the earlier the infection of the fetus occurs, the greater the likelihood of serious damage to it. So, such developmental disorders of the fetus are associated with cytomegalovirus, such as:

hydrocephalus and the formation of calcifications in the brain of a newborn;
microcephaly;
congenital chorioretinin;
congenital deafness and blindness;
jaundice;
neonatal pneumonia.

Accordingly, if the risk of infection of the fetus exists, it should be minimized. To do this, when managing pregnancy, doctors adhere to special tactics.

Pregnancy management with an eye on cytomegalovirus

Women who already have immunity against CMV infection should carefully monitor their well-being during pregnancy. At the first hint of a disease, they need to see a doctor, take the appropriate tests and, if necessary, start treatment as soon as possible: if the virus activity is suppressed in a timely manner, infection of the fetus can be avoided.

If it is unequivocally established that the primary infection occurred in the first weeks of pregnancy, the development of the fetus is carefully monitored. If he has obvious developmental disorders, in exceptional cases, artificial termination of pregnancy may be recommended.

Women without immunity to cytomegalovirus need to re-determine the presence of antibodies to it every 4-6 weeks. If suddenly during pregnancy these immunoglobulins begin to be detected, urgent measures must be taken to combat the virus.

In parallel, when antibodies to CMV are detected in seronegative women, their amniotic fluid is taken for analysis to determine whether the fetus has become infected, and treatment is started.

Also, from the very beginning of gestation, such pregnant women are advised to carefully observe the rules of hygiene, visit less public places, do not communicate with young children, who are most often active carriers of the virus, and if their spouses or sexual partners have immunity to cytomegalovirus, stop until childbirth having sex.

The very same treatment of CMV infection in pregnant women is similar to that in other patients and differs only in some details.

Treatment of CMV infection in pregnant women

A feature of the treatment of cytomegalovirus infection in pregnant women is the inadmissibility of their use of loading doses of antiviral drugs - Ganciclovir and Foscarnet. These medicines can cause serious side effects, and the disruption to fetal development due to their use may be greater than the effects of the virus itself on the fetus.

However, in small doses, both of these drugs are acceptable, but they should be taken only as directed and under the supervision of a doctor.

The same goes for Panavir. Pregnancy is a contraindication to its use, but in some cases - especially when the mother's body is resistant - the doctor may prescribe it.

As a prophylaxis, pregnant women should use human immunoglobulin. The mildest and most recommended drug here is Octagam, prescribed for intravenous administration once a month.

If an exacerbation of the infection occurs, it is necessary to use a stronger enriched Cytotect.

Features of delivery

It is important to understand that infection of the fetus can occur not only during its development, but also at the very moment of childbirth. Many cases of neonatal cytomegalovirus infection are associated precisely with the infection of the child during his passage through the mother's birth canal.

This scenario can only occur if the mother has a primary exacerbation or recurrence of infection a few days before delivery. These are very rare cases, but they do occur in medical practice. Here doctors can choose two ways:

Allow normal delivery with the risk of infection of the baby. This is justified for the reason that the infection itself does not always occur, and even with it, most babies suffer the infection without consequences;
Perform a caesarean section. In this case, the risk of infection of the newborn is minimized. However, cytomegalovirus infection on its own is almost never an indication for caesarean section, but in most cases it is an additional argument in favor of this operation.

In most cases of pregnancy complicated by CMV infection, the result is the birth of a normal healthy baby, without any damage or abnormalities.

That is why, with all the warnings about cytomegalovirus, you need to treat them exactly as warnings: keep them in mind, but not really worry about them. Remember: in a healthy body of a future mother, the probability of activation of the virus is small, and therefore the child, if the pregnancy is properly managed, will almost certainly be healthy and with normal development.

Cytomegalovirus and pregnancy: a dangerous neighborhood

Pregnancy is a condition in which the immune system of the fair sex is weakened and subject to difficult trials. Because of this, a woman in a position may face various diseases and experience them for herself. It is known that diseases during childbearing can adversely affect him. Of particular danger is cytomegalovirus during pregnancy. It can cause abnormalities in the development of the fetus or even its death in the womb.

What is cytomegalovirus and what are the ways of infection?

Probably, there are no people in the world who have not experienced such a disease as herpes. In the people it is called "cold". Herpes, appearing on the lips and face, spoils the appearance and delivers a lot of uncomfortable sensations (itching, burning). It is known that this virus, when it enters the human body once, remains in it forever, making itself felt only at those moments when the immune system is weakened.

The herpesvirus family includes the genus Cytomegalovirus. Scientists learned about its existence in 1956. Currently, cytomegalovirus infection (cytomegaly) is very common. On the planet, many people can be diagnosed with a positive cytomegalovirus. However, some do not even know about the presence of an infection in the body - it absolutely does not manifest itself, like other viruses that are members of the herpesvirus family. All the unpleasant symptoms and consequences of the disease are felt only by those people who have a weakened immune system. Pregnant women are one of the main risk groups.

What happens after the introduction of cytomegalovirus into the human body? The name of the disease "cytomegaly" in translation means "giant cell". Due to the action of cytomegalovirus, the normal cells of the human body increase. Microorganisms, getting into them, destroy the cellular structure. Cells fill with fluid and swell.

You can get infected with cytomegalovirus during pregnancy in several ways:

sexual contact, which is the main mode of infection among the adult population. Cytomegalovirus can enter the body not only through genital contact, but also through oral or anal sex without the use of a condom;
household way. Infection with cytomegalovirus in this case is rare, but possible if it is in an active form. The virus can enter the body through saliva when kissing, using one toothbrush, dishes;
by blood transfusion. In medical practice, there have been cases when infection with cytomegalovirus infection occurred during transfusion of donor blood and its components, transplantation of tissues and organs, use of donor eggs or sperm.

This viral infection can enter the body of a child: while he is in the womb, during childbirth or during breastfeeding.

The variety of transmission routes is due to the fact that the virus can be found in blood, tears, breast milk, semen, vaginal secretions, urine, saliva.

Symptoms of cytomegalovirus

If a person has strong immunity, then the virus does not manifest itself. It is in the body in the form of a latent infection. Only when the body's defenses are weakened does it make itself felt.

A very rare manifestation of the activity of this virus in people with a normal immune system is a mononucleosis-like syndrome, which is manifested by high fever, malaise, and headache. It occurs about a day after infection. The duration of a mononucleosis-like syndrome can be 2-6 weeks.

Most often, during pregnancy and cytomegalovirus, symptoms occur that resemble SARS. That is why many pregnant women take cytomegalovirus for a common cold, because almost all of its symptoms are observed: fever, fatigue, weakness, runny nose, headaches, enlargement and inflammation of the salivary glands, and sometimes even tonsils become inflamed. The main difference between cytomegalovirus infection and ARVI is that it lasts much longer - about 4-6 weeks.

In an immunodeficient state, cytomegalovirus infection can occur with complications, namely with the occurrence of the following diseases: pneumonia, arthritis, pleurisy, myocarditis, encephalitis. Vegetative-vascular disorders and multiple lesions of various internal organs are also possible.

In generalized forms, which are extremely rare, the disease spreads to the entire body. In such cases, the following symptoms are distinguished:

inflammatory processes of the kidneys, pancreas, spleen, adrenal glands, liver tissue;
damage to the digestive system, lungs, eyes;
paralysis (it occurs in extremely severe cases);
inflammatory processes of brain structures (this leads to death).

It is worth emphasizing once again that cytomegalovirus infection is mainly manifested by symptoms similar to a cold. All other of the above symptoms occur extremely rarely and only in cases of a very weakened immune system.

The danger of cytomegalovirus during pregnancy

Very dangerous is the infection of the virus in the first trimester of pregnancy. Cytomegalovirus can cross the placenta into the fetus. Infection can cause its intrauterine death.

If infection occurs later, then the following situation is possible - the pregnancy will continue, but the infection will affect the internal organs of the child. A baby can be born with congenital deformities, various diseases (dropsy of the brain, microcephaly, jaundice, inguinal hernia, heart disease, hepatitis).

Terrible consequences can be avoided if the virus is detected on time, so it is very important to plan a pregnancy and get tested for any infections before conception, as well as regularly visit a doctor during an “interesting situation”. With proper treatment, the baby can be born healthy, being only a passive carrier of cytomegalovirus.

Analysis for cytomegalovirus during pregnancy

It is almost impossible to find out about the presence of cytomegalovirus in your body on your own. The virus, being in a latent form, absolutely does not manifest itself. When active, the infection can be confused with another disease. To detect the virus, it is necessary to be tested for cytomegalovirus during pregnancy, or rather, for TORCH infection. With the help of it, the presence or absence of not only cytomegalovirus, but also toxoplasmosis, rubella, herpes simplex virus (1-2 types) is detected.

Cytomegalovirus is diagnosed using the following methods:

polymerase chain reaction;
cytological examination of urine and saliva sediments;
serological studies of blood serum.

The polymerase chain reaction is based on the determination of deoxyribonucleic acid, which is the carrier of the hereditary information of the virus and is contained within it. Scrapings, blood, urine, sputum, saliva are used for research.

In cytological examination, the material (urine or saliva) is examined under a microscope. Cytomegalovirus in a smear during pregnancy is diagnosed by the presence of giant cells.

The purpose of serum serological testing is to detect antibodies that are specific for cytomegalovirus. The most accurate method is enzyme immunoassay (ELISA), which provides the determination of different types of immunoglobulins (IgM, IgG).

Immunoglobulins are proteins produced by blood cells. They bind to pathogens that enter the body and form a complex.

Immunoglobulins M (IgM) are formed 4-7 weeks after infection. Their level decreases with the development of the immune response, and the amount of immunoglobulins G (IgG) increases.

In the results of the analysis for cytomegalovirus, several options can be indicated:

In the first case, the female body did not come into contact with cytomegalovirus, which means that preventive measures should be taken and situations in which you can become infected should be avoided.

The second analysis indicates that the female body met with the virus, but at the moment it is in an inactive form. Primary infection during pregnancy can not be feared, but there is a risk of reactivation of the virus.

The third analysis suggests that primary infection has occurred or reactivation of the cytomegalovirus, which was in the body in a latent form, is developing.

It is worth noting that IgM is not always detected. Doctors are guided by the level of IgG. Normal IgG levels may vary from woman to woman. It is advisable to take tests before conception. This allows you to determine the rate of cytomegalovirus during pregnancy. The reactivation of the virus is indicated by the number of IgG, which increases by 4 or more times.

Treatment of cytomegalovirus during pregnancy

Unfortunately, there are no means to permanently get rid of cytomegalovirus. No medicine can destroy the virus in the human body. The goal of treatment is to eliminate symptoms and "keep" cytomegalovirus in an inactive (passive) state.

For pregnant women who have a virus, doctors prescribe vitamins, immunomodulatory drugs that strengthen the immune system. This is done if the infectious process is latent (hidden). Drugs aimed at strengthening the immune system are prescribed as a preventive measure.

You can support your immune system with herbal teas. Herbal preparations are sold in pharmacies. You can ask your doctor about which herbs are suitable for pregnant women. Some of them are very useful, while others are contraindicated, as they can provoke a miscarriage. The doctor will tell you what is the best composition of tea to choose, and recommend herbal preparations that can be purchased at any pharmacy.

If the disease is active, then immunomodulatory drugs, vitamins and teas alone will not be enough. Doctors prescribe antiviral agents. The goal of treating cytomegalovirus during pregnancy is to avoid complications. Such therapy will allow women in the position to bear the baby and give birth to him healthy without any deviations.

CMV can provoke the occurrence of a number of concomitant diseases (for example, SARS, pneumonia). Successful treatment of cytomegalovirus infection depends on the treatment of the other underlying disease. The use of drugs for the treatment of concomitant diseases in combination with antiviral and immunomodulatory drugs will make it possible to recover and bring the cytomegalovirus into an inactive form when its activity is controlled by the immune system.

It is impossible to treat cytomegalovirus infection on your own. Only a professional doctor can prescribe the necessary drugs. He makes his decision based on the form of the infection, the state of the patient's immunity, her age, and the presence of concomitant diseases. A woman who wants to give birth to a healthy child must follow all the doctor's recommendations.

Prevention of cytomegalovirus

Not all people are carriers of cytomegalovirus. A woman who is not infected with it and is planning a child or is already in a position must comply with preventive measures. They will also be useful for those people in whose body the virus is in a "sleeping" state.

First, women who wish not to encounter cytomegalovirus during pregnancy should avoid casual sex. Do not have sex without a condom. Doctors remind their patients of this all the time. If you follow this recommendation, you can protect yourself not only from cytomegalovirus, but also from other serious sexually transmitted diseases.

Secondly, it is necessary to keep your home and yourself clean, follow the elementary rules of personal hygiene, which are instilled in all of us from an early age. For example, you can not use someone else's dishes, washing accessories (washcloths, towels), as there is a small risk of contracting cytomegalovirus through them. Before eating, before and after going to the toilet, after contact with other people's objects (for example, money), you need to wash your hands thoroughly.

Be sure to strengthen your immune system. To do this, it is recommended to do daily physical exercises that are recommended for pregnant women, walk more often in the fresh air, and perform hardening procedures. Good immunity will not allow the occurrence of an acute cytomegalovirus infection, but will “keep” the pathogens in an inactive form.

A balanced diet plays a huge role. Unfortunately, many people do not watch their diet, eat their favorite foods, refusing healthy foods (for example, vegetables). The menu should be designed in such a way that it contains food containing vitamins and nutrients in the required amount. Due to their lack, the immune system can weaken, and this is fraught with various diseases. There is no need to go on a restrictive diet during pregnancy, as this will not lead to anything good either.

In order not to encounter cytomegalovirus infection and its complications during pregnancy, it is necessary to plan conception in advance. Cytomegalovirus when planning pregnancy can be detected through testing. Examinations should be carried out not only by a woman, but also by her man.

In conclusion, it is worth noting that cytomegalovirus infection is very dangerous for a pregnant woman. Masquerading as a common cold, it can lead to terrible consequences (especially in the initial period). If you experience cold symptoms during pregnancy, you should immediately consult a doctor, because it may be a cytomegalovirus infection. It is not necessary to self-medicate, since self-selected drugs may not help, but only harm.

How to give birth to a healthy child with cytomegalovirus?

Women planning a pregnancy are interested in the question of what is the probability of giving birth to a healthy child if the expectant mother has cytomegalovirus. Infection of the fetus during this period of life can lead not only to a serious illness, but also to the death of an unborn baby in the womb. It is this danger that occurs with cytomegalovirus, so it is important to have all the information that relates to such a disease.

What is the disease?

Cytomegalovirus infection is a disease that occurs as a result of the influence of a specific virus on the cells of the human body.

This virus belongs to the family of herpes viruses, it can be found in body fluids: blood, semen, urine, saliva. Initially, the virus is fixed in the salivary glands, where it multiplies, and then enters with the blood into any organ or tissue. For adults with good immunity, there is no great danger, it is more difficult with immunodeficiency and pregnancy.

Ways of infection

You can get infected in the following ways:

through the blood;
during blood transfusion;
through saliva;
through mother's milk;
vertically - from mother to child during pregnancy;
sexually;
household way;

The virus is activated against the background of a decrease in immune defense.

Most often, the virus does not manifest itself. Activation occurs due to a decrease in immunity, hypothermia, stress. There are no specific symptoms, because this pathogen can act in any organ or part of the body. It is important to note that the transmission of the virus occurs from a person with an active form. Cytomegalovirus poses the greatest danger to pregnant women, as it can lead to the development of fetal abnormalities or to termination of pregnancy.

According to statistics, 10-15% of adolescents, 40% of adults are infected with this virus. It also creates a problem that it is not easy to identify this pathogen simply because the incubation period is about 60 days. In addition, cytomegalovirus hides under the masks of diseases such as acute respiratory infections, pneumonia, and arthritis.

Planning for pregnancy with CMV

To say that it is important to protect yourself and the unborn child from cytomegalovirus is to say nothing. It is for this that there is an analysis for TORCH infection, which includes the identification of diseases such as toxoplasmosis, rubella, herpes virus and cytomegalovirus. These tests are optional, but are recommended when planning a child. With the help of such a simple procedure, possible risks and complications are determined.

Is it possible to have a healthy baby with CMV?

It is impossible to give an unambiguous answer to this question. It all depends on the woman herself and her willingness to be treated in order to give birth to a healthy child. There are two forms of this infection - acute and chronic. Chronic course means that the mother's body already has antibodies to the virus and they are able to resist the passage of the infection through the placenta to the fetus, and the probability of the child getting sick is 1%.

In the acute form, a woman must first undergo a course of treatment, and only then plan a pregnancy, because it is this course that will lead to infection of the fetus. If infection occurs during the development of the child, then the pregnancy will continue, but subsequently anomalies and various diseases may develop, which depends on the period, immunity and other factors.

Features of pregnancy and childbirth

In the presence of a chronic form of this disease or if the presence of cytomegalovirus in the mother is suspected, the main thing is a quick and reliable diagnosis. The recommended method is blood culture on a nutrient medium. If the presence of the pathogen is confirmed, the woman must undergo a course of carefully selected powerful therapy, which will significantly reduce the risk of the virus entering the fetus. The main drug of this kind is "Immunoglobulin".

It is important that infection of the child can occur during childbirth, namely due to the ingestion of mucus from the cervix or vaginal discharge, where the virus is located. Do not forget that the pathogen can be transmitted through breast milk. That is why, if the child is not infected during the prenatal period, he will be bottle-fed. After delivery, congenital CMV infection must be confirmed within 14 days.

We can unmistakably say that the health of the child is in the hands of his mother, and by observing the elementary rules for the prevention of cytomegalovirus infection, you can significantly reduce the risk of developing this disease. Rational nutrition, sufficient intake of vitamins strengthen the immune system and help to resist infection.

Cytomegalovirus infection and pregnancy

Cytomegalovirus (CMV) consists of two strands of DNA and belongs to the group of herpes viruses (Herpesviridae), which includes 8 types of human herpes viruses. It is one of the largest viruses in this group. Unlike the herpes simplex virus, CMV replicates very slowly. Although CMV can infect many cells in the human body, it most often replicates in fibroblasts. Very little is known about the mechanism of tissue damage by this virus at the molecular level. Cytomegalovirus is a virus of paradoxes, because it can be a silent life partner in the human body or become a potential killer under certain conditions. This is one of the most dangerous viruses for newborns, since CMV infection can cause mental retardation and deafness in children. Cytomegalovirus was first isolated in culture in 1956. It is believed that animals may have their own specific strains of CMV that are not transmitted to humans and are not infectious agents in humans. CMV is transmitted from person to person through contact with infected blood, saliva, urine, and also sexually. The latent (incubation) period lasts from 28 to 60 days, with an average of 40 days. Viraemia always occurs during primary infection, although it is difficult to detect in recurrent infection.

The protective reaction of the body is very complex, and is divided into humoral and cellular. The production of glycoproteins B and H is a manifestation of humoral protection. Cellular immunity consists of the production of a large amount of proteins. The infectious agent causes the appearance in the blood of antibodies - immunoglobulins IgM, which disappear, on average, within a day, although they can be found weeks after infection. The presence of the virus in the blood (viremia) can be determined 2-3 weeks after the initial infection. In most cases, the infection process is asymptomatic. Re-infection may occur due to the reduplication of an existing virus or infection with a new strain of CMV. This virus is dangerous for organ transplant patients, cancer patients, and AIDS patients who have suppressed immune systems.

According to studies conducted in many countries, as well as according to incidence statistics, CMV is infected from 40 to 60% of the population aged 35 years, and almost 90% of the population aged 60 years in most developed countries. In developing countries, infection with the virus occurs in early childhood, and almost 100% of the adult population are carriers of this virus. Cytomegalovirus is present in the body of 60 to 65% of American women of reproductive age. Most often, infection of women occurs at age. A greater number of infected women are observed among low social strata, which is assumed to be due to poor hygiene.

Primary infection occurs in 0.7-4% of all pregnant women. Recurrent infection (reactivation) may occur in 13.5% of infected pregnant women. Secondary infection, but with other strains of cytomegalovirus, can also be observed in some cases.

With primary infection, infection of the fetus occurs in 30-40% of cases, and according to some data from European scientists, infection of the fetus can be observed in 75% of cases. With reactivation of the current infection, the transmission of the virus to the fetus is observed only in 0.15-2% of cases. Congenital CMV infection is present in 0.2-2% of all newborns. A high incidence of CMV infection is observed in kindergartens. According to some data, it is children who are the biggest source of infection for their family members (horizontal transmission).

Low level of education

Age up to 30 years

Having or having had a sexually transmitted disease in the past

Numerous sexual partners

Close contact with children under 2 years of age

Manifestation of cytomegalovirus infection

Most people (95-98%) infected with CMV are asymptomatic when first infected, although occasionally some of them may have complaints similar to those observed in patients with mononuclease. Symptoms include fever, sore throat, muscle pain, weakness, and diarrhea. Sometimes there is a rash on the skin, enlarged lymph nodes, inflammation of the nasopharynx, an increase in the size of the liver and spleen. Blood tests may show thrombocytopenia, lymphocytosis or lymphopenia, and elevated levels of liver enzymes.

CMV infection, both primary and recurrent, is very dangerous for immunocompromised patients after organ transplantation, HIV carriers, cancer patients, and in them the infection can manifest itself in the form of inflammation of the lungs, kidneys, retina and organs of the gastrointestinal tract.

Fetal infection and congenital CMV infection

Transmission of CMV from mother to fetus occurs in the form of vertical transmission during the primary infection of a woman or during the reactivation of her infection. Unfortunately, the mechanism of transmission of the virus to the fetus is poorly understood. The primary infection of the mother is more dangerous for the fetus and causes more damage to it than the reactivation of the old infectious process. The CMV virus is transmitted to the fetus through the placenta in any period of pregnancy in the same way. If the infection of the mother occurred in the first trimester, then in about 15% of these women, the pregnancy ends in a spontaneous miscarriage without a viral infection of the embryo itself, that is, the infectious process is found only in the placenta. Therefore, there is an assumption that the placenta is first infected, which still continues to function as a barrier in the transmission of CMV to the fetus. The placenta also becomes a reservoir for CMV infection. It is believed that CMV replicates in the placental tissue before it infects the fetus. In primary infection, maternal leukocytes carry the virus into the endothelial cells of the microvessels of the uterus.

90% of infected fetuses show no signs of infection. Scientists in Belgium were trying to figure out exactly when it is possible to diagnose fetal infection in women with a primary infection. They concluded that congenital CMV infection in the fetus can be reliably confirmed by amniotic fluid polymerase chain reaction (PCR) after 21 weeks of gestation, with an interval of 7 weeks between the diagnosis of primary infection in the mother and diagnostic amniocentesis. Between 5 and 15% of infected newborns will have signs of CMV infection after delivery.

Infection of the child can occur during childbirth when he swallows the cervical mucus and vaginal discharge of the mother. This virus is also found in breast milk, so more than half of breastfed children will become infected with CMV infection in the first year of life.

The manifestation of congenital CMV infection is characterized by a lag in growth and development, an enlarged spleen and liver, hematological abnormalities (thrombocytopenia), skin rashes, jaundice and other signs of infection. However, damage to the central nervous system is the most dangerous manifestation of the disease, in which microcephaly, ventriculomegaly, cerebral atrophy, chorioretinitis, and hearing loss are observed. Calcifications are found in the brain tissue, the presence of which is a prognostic criterion for the development of mental retardation and other neurological abnormalities in infected children in the future.

The mortality rate of newborns who develop symptomatic infection is very high, and according to some data is from 10 to 15% of cases. The rest of the surviving 85-90% of children may experience neurological abnormalities and mental retardation. Since 90% of all infected fetuses have no signs of infection at birth, the prognosis for these newborns is very favorable, but 15-20% of these children may develop unilateral or bilateral hearing loss during the first years of life. Therefore, in terms of monitoring, it is important to conduct regular audiological tests in children infected with cytomegalovirus.

Over the past thirty years, many laboratories around the world have developed a lot of diagnostic methods for detecting CMV in the human body. It is important to carry out a diagnostic study in pregnant women at the slightest suspicion of the presence of a cytomegalovirus infection, especially in primiparas, as well as in case of an unfavorable outcome of a previous pregnancy and in case of clinical manifestation of CMV infection during pregnancy.

Seroconversion is a reliable method for diagnosing primary CMV infection if the woman's immune status has been documented prior to pregnancy. The appearance of de novo virus-specific IgG in the serum of a pregnant woman indicates the primary infection of the woman. However, this diagnostic method was abandoned in many developed countries, because a reliable determination of the immune state of a woman before pregnancy is often impossible or it is carried out in many laboratories using non-standard (commercial) methods for diagnosing CMV infection.

Determination of CMV-specific IgM can help in the diagnosis of infection, however, the appearance of CMV-specific IgM antibodies can be delayed up to 4 weeks, and these immunoglobulins are found during recurrent infection in 10% of women. These same antibodies may be present in some patients for months after the initial infection. In addition, false positive results can be observed in the presence of the Epstein-Barr virus in the human body. Determining the level of IgM antibodies in dynamics (quantitative method), that is, its rise or fall in several blood samples, can help in determining the primary infection of pregnant women, since the change in this level has its own specifics. If during pregnancy the level of IgM immunoglobulins drops sharply, then it is assumed that the primary infection of the woman occurred during pregnancy. If the level of antibodies decreases slowly, then, most likely, the primary infection occurred several months before pregnancy.

Unfortunately, among the commercial diagnostic methods based on the ELISA test and used to detect IgM antibodies, there is a lack of standard requirements for the preparation of viral material for research, as well as a disagreement in the interpretation of the results. Qualitative and quantitative determination of the level of IgG immunoglobulins in dynamics is becoming a fairly popular method for determining the immune status due to the low cost, however, for a more reliable diagnosis of an active primary infection, additional examination methods are necessary.

The response of the body to CMV in the form of the appearance of neutralizing antibodies, which disappear 14-17 weeks after the onset of the primary infection, is a reliable indicator of the primary infection. If they are not found in the blood serum of an infected person, then this indicates that the infection occurred at least 15 months before the diagnosis. Cytological examination reveals typical giant cells with intranuclear inclusions, but is not a reliable method for diagnosing CMV infection.

Complement fixation test (RCT) is used in a number of laboratories, but this method is best used in combination with other diagnostic methods.

Cytomegalovirus is found in various body fluids and tissues, such as saliva, urine, blood, vaginal secretions, however, its detection in human biological tissues cannot determine whether the infection is a primary or reactivation of the current infection. The classic isolation of a cell culture of the virus, the results of which previously had to wait sometimes 6-7 weeks, has been replaced in many laboratories by the detection of CMV in the blood using the method of fluorescent antibodies and obtaining the result within hours.

Qualitative and quantitative determination of CMV DNA, in almost any fluid of the human body, as well as tissues, is carried out using the polymerase chain reaction (PCR) method with an accuracy of 90-95%. Over the past decade, several new methods have appeared, the so-called molecular biological methods for diagnosing viral infections, based on the detection of the virus, its DNA and other components of the genome in the blood serum (viremia, antigenemia, DNA-emia, leuko-DNA-emia, RNA- emia). Maternal predictive markers of fetal infection are under development.

Diagnosis of CMV infection in the fetus

Determination of IgM in the blood of the fetus is not a reliable diagnostic method. Currently, the detection of a virus culture in amniotic fluid and polymerase chain reaction (PCR) make it possible to make a correct diagnosis in % of cases. The level of all virological parameters (viremia, antigenemia, DNAemia, etc.) in the blood of fetuses with developmental abnormalities is higher than in fetuses with no abnormalities found. Also, the level of specific IgM immunoglobulins in normally developing fetuses is much lower than the level of these antibodies in children with developmental disabilities. These data suggest that congenital CMV infection in infected fetuses with normal biochemical, hematological and ultrasound signs, as well as low levels of the virus genome and antibodies to it, has a more favorable outcome.

Determination of viral DNA in amniotic fluid can be a good prognostic factor: its level is lower if the fetus does not have developmental abnormalities.

Negative test results are not a sure sign that the fetus is not infected. The risk of transmission of the virus from mother to child during diagnostic procedures in the presence of viremia in the mother is small.

Ultrasound signs of infection in the fetus

intrauterine fetal growth retardation

Calcifications in the liver and intestines

CMV infection in most cases does not require treatment. Of the antiviral drugs used to treat this infection, ganciclovir, cidofovir and foscarnet, which have an inhibitory effect on herpes viruses. The effect of these drugs on the body of a pregnant woman and the fetus has not been fully studied. The use of antiviral drugs is also limited in pediatrics due to the high toxicity of drugs.

The ideal characteristics of antivirals in the treatment of pregnant women may be (1) prevention of transmission of the pathogen from mother to fetus and (2) low toxicity. However, most often, the diagnosis of CMV infection is carried out in pregnant women when the fetus is already infected.

Treatment with CMV-specific monoclonal antibodies in infected children is under investigation.

Management of pregnancy, childbirth and the postpartum period in women with CMV infection

It is important to carry out sanitary and educational work in antenatal clinics with the provision of the necessary information about diseases, diagnostic methods and types of treatment, including CMV infection.

Compliance with sanitary and hygienic standards during pregnancy and personal hygiene play an important role in the prevention of many diseases, primarily infectious ones.

Early diagnosis of infection in mother and child. Scientists are trying to decide how important it is to determine the timing of primary infection in pregnant women from a prognostic point of view. It is assumed that if a woman was infected a few days before conception, then the risk of infection of the fetus is lower than in women infected during pregnancy. The earlier the primary infection occurred in a pregnant woman, the greater the chance of infection of the child and the appearance of congenital CMV infection.

Consultation of an infectious disease specialist, microbiologist, neuropathologist, perinatologist, psychologist and, if necessary, other specialists are important when discussing the prognosis of pregnancy and its outcome.

The issue of hospitalization of pregnant women with primary CMV infection when abnormalities are found in the fetus and / or 2 weeks before delivery still causes a lot of controversy. In some countries, a woman is offered an abortion if the child has a lot of developmental abnormalities and the prognosis for a favorable pregnancy outcome is low.

Women who actively shed the virus during pregnancy may give birth on their own, as a caesarean section does not offer any benefit in protecting the baby from infection.

CMV is found in the breast milk of breastfeeding mothers, so it is important to warn a woman that her baby may be infected with this virus while breastfeeding.

After delivery, it is important to confirm the diagnosis of congenital CMV infection within the first two weeks, and to differentiate between primary infection during childbirth through the birth canal or infection through milk during the first days of breastfeeding. The gold standard method for diagnosing congenital infection is the isolation of CMV in human fibroblasts.

Compliance with the rules of personal hygiene by medical staff and the appropriate disinfection regime should be carried out in any medical institution, and especially in maternity wards.

It is advisable to inform an infected woman about the risk of transmitting CMV to other members of her family, as well as about measures to prevent CMV infection.

Many laboratories are developing a CMV vaccine. However, no country in the world has a registered vaccine that could prevent primary infection, as well as the occurrence of congenital CMV infection. Inoculations with suppressed CMV strains are already being effectively used in a number of medical centers in the United States and Europe in patients with transplanted kidneys.

Since cytomegalovirus is transmitted through infected body fluids, it is important to practice good hygiene, which includes frequent hand washing, avoiding kissing on the mouth, and not sharing utensils and personal hygiene items. Women who work in settings at high risk of CMV infection are recommended to determine the immunological status before conception. Passive immunization with immunoglobulins (CytoGam, Cytotec) is performed to prevent symptomatic CMV infection in patients who have undergone kidney and bone marrow transplantation, and usually in combination with antiviral drugs, as well as newborns and young children in the acute period of infection.

Questions about the universal screening program

Is there a universal screening program for the detection of CMV infection and other infections transmitted intrauterinely from mother to fetus?

There is no universal screening program for the detection of viral infections in any country in the world, as well as there is no standard program for screening non-pregnant and pregnant women for the presence of CMV infection. This is due to the fact that a universal scheme of diagnostic methods that can be used in the daily practice of a doctor has not yet been developed, and the existing numerous commercial diagnostic tests create confusion in the diagnosis of CMV and the interpretation of examination results, in all countries without exception.

Should non-pregnant women be tested for CMV infection?

From 1995 to 1998, only in Italy, non-pregnant women were offered a free ToRCH test, but this diagnostic method was abandoned due to the lack of information of this analysis in detecting CMV and other infections.

Should pregnant women be screened for infectious diseases?

Practically, in all countries of the world there are official recommendations for the detection of a number of infections in pregnant women (toxoplasmosis, rubella, HIV carriage, hepatitis B, gonorrhea, syphilis), but there are no recommendations for CMV infection, herpes infection, parvovirus infection and others. This is due to the lack, first of all, of universal screening programs for these diseases. Most doctors in Italy, Israel, Belgium and France offer a pregnant woman to be diagnosed with CMV infection. In Austria, Switzerland, Germany and Japan, the determination of CMV-specific antibodies is carried out at the request of a pregnant woman. In the Netherlands, the UK, Austria and Japan, screening of pregnant women for CMV infection is recommended for women working in settings with the potential for infection (hospitals, schools, kindergartens) or in the presence of contact with patients or carriers of CMV infection.

Many doctors are of the opinion that CMV testing of all pregnant women is not rational, because (1) there is still no vaccine that could prevent congenital CMV infection, (2) diagnostic tests offered in different countries of the world, and even in different medical institutions in the same country, often have different standard parameters, and therefore the results of such a survey are difficult to interpret, (3) congenital CMV infection occurs both during primary infection and during reactivation of the current infection, but its negative consequences are the same for any transmission of the virus from mother to fetus, (4) antiviral drugs for the treatment and prevention of CMV infection are very dangerous due to toxicity, so their use in pregnant women is limited.

Most doctors diagnose CMV infection when there are symptoms of infection in the mother or child.

Should women of reproductive age be informed about infectious diseases, including CMV infection, and recommended for screening before or during pregnancy?

Most researchers in the field of virology and microbiology are of the opinion that women of reproductive age, when preparing for pregnancy, should be informed about the existence of a number of pathogens that are dangerous during pregnancy for the unborn child, as well as the newborn, but they do not recommend testing, including CMV infections , due to the lack of a vaccine and specific therapy that could be used to prevent congenital CMV infection. It is believed that it is necessary to conduct health education among women of reproductive age and to teach the prevention of viral and other types of infections. However, it is expected that if informative low-cost screening tests were developed that can reliably determine a woman's immune status, such a diagnosis would allow precautionary measures to be taken in sero-negative women, as well as suggesting that they be re-examined during pregnancy. Unfortunately, the commercial methods for diagnosing CMV infection on the market raise serious doubts about the reliability of the test results. Many women first learn about the existence of CMV infection only after receiving test results from laboratories, when the laboratory assistants themselves provide incorrect information, commenting on the CMV-specific IgM antibodies found in women, and suggest urgent treatment. There is also a very serious problem in terms of the education of doctors and their competence in correctly interpreting the results of diagnostic tests. Many physicians prescribe treatment to women based only on the results of one commercial analysis, and very often this treatment is not only not justified, but also dangerous due to the toxicity of antiviral drugs. Therefore, researchers believe that universal testing of women of reproductive age has more negative consequences for women themselves than positive ones, due to the illiteracy of many doctors regarding CMV infection, as well as a number of other viral diseases. Italy is the only country in the world where women are prepared for pregnancy by specially trained medical personnel. The tasks of nurses, midwives and doctors include providing important information about infectious diseases that are dangerous for a pregnant woman and fetus, training in prevention methods, explaining diagnostic methods for detecting a number of infections, as well as general recommendations for preparing a woman for pregnancy.

If a pregnant woman is diagnosed for the presence of a current CMV infection, then what exactly should be determined?

Doctors specializing in virology and immunology suggest not to determine CMV-specific IgM immunoglobulins, but IgG immunoglobulins. If a woman is IgG-seropositive, then she should be informed about this, and such a woman does not need additional examination. In IgG-sero-negative women, education on CMV infection prevention should be provided, as well as additional testing during pregnancy (in the first and third trimester). In women with questionable results, the researchers suggest testing IgG and IgM levels in multiple serum samples.

Cytomegalovirus infection is a very common infection, both among the adult population and among children. However, diagnostic methods of examination, interpretation of test results and the appointment of appropriate treatment for CMV infection should be carried out correctly, taking into account the data of modern virology and immunology. The question of testing all non-pregnant and pregnant women for CMV carriage still causes a lot of controversy in medical circles. The doctor may recommend a series of tests to determine the immunological status of a woman who is preparing for pregnancy, however, these recommendations should not be prescriptive, and the decision in terms of diagnosing CMV infection should be made by the woman herself. Establishment of pre-pregnancy classes based on antenatal clinics and other medical institutions, as well as holding educational conferences and seminars for medical personnel, would have a positive result in terms of reducing the morbidity and mortality of pregnant women and newborns.