Cytomegalovirus virus in pregnant women. How does cytomegalovirus manifest itself for the fetus during mother's pregnancy. Result: IgM and IgG negative

Cytomegalovirus (CMV) is a virus that can be passed from mother to child during pregnancy. CMV usually does not harm the fetus and rarely causes disease.

• primary (IgM)
• chronic (IgG)

Primary cytomegalovirus can cause more serious pregnancy problems than chronic. However, as statistics show, only 1% of pregnant women encounter cytomegalovirus infection for the first time.

How is the type of virus determined?

In most cases, the presence of infection is difficult to determine, because it may not give itself any symptoms. However, in infected people, antibodies to the virus remain in the blood throughout life. Thus, in order to find out whether a person is infected or not, he needs to take a blood test:

• The presence of IgM antibodies (immunoglobulin M) indicates a primary or ongoing infection,
• The presence of IgG antibodies (immunoglobulin G) indicates that the infection has occurred in the past.

There are other types of tests to detect CMV, but they tend to be more expensive than a blood test and are not universally available.

When a cytomegalovirus infection is first diagnosed in a pregnant woman, tests may be needed to determine if the virus has spread to the fetus. Usually, such a diagnostic method as amniocentesis is used, which is a puncture of the amnion cavity and allows to identify gene and chromosomal mutations. The analysis is carried out no earlier than the 16th week after conception. When the virus is affected, low levels of amniotic fluid, intrauterine growth retardation, and an increase in the tissues that form the brain are observed.

To make a diagnosis in a newborn, it is enough to analyze saliva, urine or blood.

Symptoms of cytomegalovirus

Most people infected with cytomegalovirus do not experience any symptoms, while others may experience the following symptoms:

• fever,
• tonsillitis,
• severe fatigue,
• runny nose,
• other signs of SARS,
• inflammation of the internal organs, and as a result - the development of bronchitis, pneumonia,
• violations of the normal functioning of the urinary system.

How common is CMV? At-risk groups

Cytomegalovirus is quite common: by the age of 40, over 50% of people have an infection in their body, and in developing countries the percentage is even higher.

The risk group includes:

• people working with children
• children in the womb,
• people with a weakened immune system, such as those who have had an organ transplant or who have HIV.

How is the virus spread?

CMV prefers to be in any body fluids - saliva, sputum, urine, blood, semen, breast milk - and therefore spreads from person to person in various ways:

• by airborne droplets,
• sexually,
• through saliva
• through blood transfusion
• from mother to child during pregnancy
• from mother to child during childbirth
• from mother to child while breastfeeding.

For the treatment of CMV, immunomodulatory drugs are prescribed to pregnant women to reduce the risk of having a child with symptoms of infection. Antibiotics and other drugs are prescribed to treat concomitant diseases.

There is no medicine that could destroy cytomegalovirus infection. Research is currently underway and attempts are being made to develop a vaccine against CMV.

CMV during pregnancy: possible consequences

Pregnancy itself is not a risk factor for infection with cytomegalovirus infection. If infection occurs, symptoms in the mother are quite rare, however, sometimes the virus can pose a threat to the developing fetus. Infection is transmitted from mother to child in 30-50% of cases, of these children, only 10-15% show signs of infection. Hereditary cytomegalovirus disease develops in 0.2-2.5% of children worldwide. Even if there are no symptoms at birth, complications such as deafness or disability may persist for a long time.

Potential problems that may arise in a child who has contracted CMV from the mother during pregnancy:

• moderate enlargement of the liver and spleen,
• red spots on the skin
• eye problems,
• convulsions.

Particularly rare complications include:

• Guillain-Barré syndrome (acute primary idiopathic polyradiculoneuritis),
• colitis (inflammation of the large intestine),
• pneumonia,
• pericarditis (inflammation of the heart bag), myocarditis,
• rupture of the spleen.

In 5-15% of cases, there are no symptoms at birth, but complications develop as they grow older: problems with hearing, coordination, mental abnormalities.

In 85-95% of cases, there are no complications at birth and they do not occur later in life.

A note to young mothers: do not give up breastfeeding - the benefits far outweigh the minimal risk of CMV transmission.

This is a clinically manifest or latent infectious disease caused by cytomegalovirus that occurs before conception or during gestation. Manifested by hyperthermia, catarrhal symptoms, cervical and submandibular lymphadenitis, sialadenitis, general intoxication, whitish-blue leucorrhea, less often - hepatomegaly, splenomegaly, generalized lymphadenopathy. It is diagnosed using serological and molecular laboratory methods. Treatment is carried out with a specific human immunoglobulin, recombinant alpha-2-interferon, in severe cases - with synthetic analogues of nucleosides.

ICD-10

B25 Cytomegalovirus disease

General information

Diagnostics

The complexity of timely detection of CMVI is associated with the absence of symptoms in most pregnant women and the polymorphism of the clinical picture during manifestation. Considering the increased risk of perinatal infection of a child with cytomegalovirus infection, an analysis for the TORCH complex is recommended as a screening. The leading diagnostic methods are laboratory tests that allow to verify the infectious agent, detect serological markers and determine the severity of the process. The plan for examining patients with suspected cytomegalovirus includes such studies as:

• Linked immunosorbent assay. ELISA is considered the most reliable and informative method for diagnosing cytomegalovirus disease. The presence of active infection confirms the detection of IgM and more than 4-fold increase in IgG titer. The duration of infection is evidenced by data on the avidity of immunoglobulins G (with an indicator<30% процесс является первичным).
• PCR diagnostics. Cytomegalovirus nucleic acids are detected in biological secretions that may contain the pathogen. Usually, blood, urine, cervical secret, buccal swabs are taken for analysis. Detection of viral DNA confirms infection, and quantitative research methods allow you to control the course of infection.

Taking into account the possibility of reactivation of the cytomegalovirus process at any stage of gestation, routine virological monitoring is recommended for carriers at 8-12, 23-25, 33-35 weeks of pregnancy. If intrauterine damage to the fetus is suspected, cordocentesis is performed with the determination of IgM in the umbilical cord blood, amniocentesis with PCR diagnostics of the pathogen in the amniotic fluid. To assess the condition of the fetus, identify placental insufficiency, possible anomalies according to indications, ultrasound of the fetus and placenta, dopplerography of the uteroplacental blood flow, fetometry, CTG, fetal phonocardiography, chorion biopsy are performed. Cytomegaly is differentiated from HIV infection, infectious mononucleosis, toxoplasmosis, listeriosis, herpes, viral hepatitis, bacterial sepsis, lymphogranulomatosis, acute leukemia. If necessary, the patient is consulted by an infectious disease specialist, virologist, immunologist, oncologist, oncohematologist.

Treatment of CMVI in pregnant women

When choosing tactics for managing gestation, the clinical form of CMVI and the duration of infection are taken into account. Women with cytomegaly, which initially manifested during the 1st trimester, are recommended to have an abortion. Termination of pregnancy for medical reasons is also indicated for patients with clinically and laboratory confirmed primary infection if ultrasound signs of fetal malformations are detected before 22 weeks. In other cases, prolongation of gestation is possible. Pregnant women with a carrier state are not prescribed medication. In the absence of clinical and laboratory signs of reactivation of cytomegalovirus disease, lifestyle changes are required to prevent significant immunosuppression. Patients need sufficient rest and sleep, exclusion of excessive physical and psychological stress, good nutrition, intake of vitamin and mineral complexes, prevention of acute respiratory viral infections, caution when prescribing drugs that reduce immunity.

Pregnant women with an active form of infection undergo treatment aimed at stopping the exacerbation and stopping the excretion of cytomegalovirus. The difficulty of choosing an adequate drug therapy is associated with the fetotoxicity of most antiviral agents. Taking into account possible indications and contraindications for the treatment of CMVI during gestation, the following are used:

• Anticytomegalovirus human immunoglobulin. Hyperimmune drugs allow you to restore the titer of specific IgG, block the replication of the pathogen and limit its dissemination. The use of human immunoglobulin significantly reduces the risk of intrauterine infection with the cytomegalovirus.
• Recombinant α-2-interferon. The drug stimulates T-helpers and T-killers, increasing the level of T-cell immunity. Enhances the activity of phagocytes and the rate of differentiation of B-lymphocytes. It inhibits the replication of cytomegaloviruses and promotes their inactivation by various immune agents. Recommended in the form of rectal suppositories.
• Synthetic nucleoside analogs. They are prescribed only for severe generalized forms of cytomegalovirus infection, when the risk of toxic effects of drugs is justified by saving the life of a pregnant woman. Antiviral drugs inhibit the DNA polymerase of viral particles and thereby inhibit the synthesis of cytomegalovirus DNA.

Inducers of interferonogenesis, immunomodulators are used extremely rarely due to the possible premature interruption of gestation. As non-drug methods, it is permissible to carry out endovascular laser irradiation of blood and. The preferred method of delivery is vaginal delivery. Cesarean section is performed in the presence of absolute obstetric or extragenital indications or with a combination of relative ones (intrauterine infection with cytomegalovirus, chronic fetal hypoxia, II-III degrees of developmental delay, primary and secondary infertility in history).

Forecast and prevention

Timely detection of latent CMVI and prevention of its activation significantly improve the outcome of pregnancy for both the woman and the fetus. The prognosis is unfavorable with generalization of primary cytomegalovirus infection. When the diagnosis of cytomegaly is established, planning of conception is shown taking into account the recommendations of an obstetrician-gynecologist, stopping the active process, pregravid immunocorrection using peptide immunostimulants and recombinant interferons. Antiviral therapy in women with overt CMVI reduces the risk of infection reactivation in the most dangerous 1st trimester by 75%. General prevention of infection involves observing the rules of personal hygiene with frequent washing of hands, avoiding close direct contact with other people.

Cytomegalovirus and pregnancy

Cytomegalovirus infection is especially dangerous during pregnancy. This danger is caused by the fact that the risk of transmission from mother to fetus is very high. occupies one of the first places in intrauterine infection of the fetus.

Particularly severe consequences can be caused by the transmission of a primary infection when cytomegalovirus enters the mother's body for the first time during pregnancy. Therefore, women in whose blood analysis were not found antibodies to cytomegalovirus, are in a certain risk group and should be especially carefully taken care of. Therefore, cytomegalovirus infection, along with rubella, toxoplasmosis and herpes, is included in the group of diseases for which women are better be examined before conception.

Infection of the fetus with cytomegalovirus can occur in different ways. The fetus can be infected during conception, since cytomegalovirus is also found in male seed.can enter the baby's body through the placenta during pregnancy. Most often, cytomegalovirus enters the body of an unborn child from uterus through the membranes. In addition, infection with cytomegalovirus can occur during childbirth, at the time the child passes through the birth canal, or after birth during breastfeeding, since cytomegalovirus is also found in the mucous membranes. vagina, through which the child passes, and in the breast milk of an infected woman. However, it should be noted that infection of a child with cytomegalovirus during and after childbirth is not as dangerous and does not lead to such terrible consequences as intrauterine infection.

When the fetus is infected during pregnancy, several options for the further development of events are possible:

• Intrauterine cytomegalovirus infection can develop asymptomatically, without consequences for the health of the child. Of course, this option can be considered optimal for this situation, since with it the probability of having a healthy child is very high. After birth, the baby will become the same passive carrier of cytomegalovirus as many people who live for many years and have no idea that they are virus carriers. Cytomegalovirus inside the fetus in this case can lead to the birth of a child with low birth weight. In the future, he can develop normally, catching up with his peers, or he can lag behind them in a number of indicators.
• A more severe option is when cytomegalovirus , intrauterine infection of the fetus, provokes the development of a severe infection, leading to intrauterine death of the fetus ( miscarriage, spontaneous abortions, stillbirth). Usually this flow CMV characteristic of infection of the fetus in early pregnancy, usually before 12 weeks of gestation.

If the fetus survives after infection with cytomegalovirus or infection occurs at later stages of pregnancy, then the child can be born with.

It manifests itself immediately after birth with malformations, including an underdeveloped brain, dropsy of the brain,,, an increase liver and spleen, pneumonia, , congenital deformities. A child born may suffer from mental retardation, deafness, epilepsy, cerebral palsy, muscle weakness.

In other cases congenital CMV manifests itself only in the 2-5th year of the life of an infected child with blindness, deafness, speech inhibition, mental retardation, psychomotor disorders.

In connection with the possibility of all such disorders during pregnancy, in some cases, it is an indication for her artificial interruption. At the same time, the decision of the doctor leading the pregnancy is based on medical indications, virological examination data and Ultrasound studies fetus and placenta.

Let us emphasize once again that congenital cytomegalovirus infection is observed almost exclusively in children whose mothers become infected with cytomegalovirus for the first time during pregnancy, and are not its carriers. The fact is that during the primary infection in the body of a pregnant woman there are no antibodies to cytomegalovirus, and therefore unattenuated cytomegalovirus quite easily penetrates the placenta and affects the fetus, which infection in this case occurs in almost half of the cases.

To avoid primary infection, a pregnant woman is advised to limit social contacts, especially with children. The latter may be sick with a congenital form of CMV and release the virus into the external environment for up to 5 years.

If antibodies to cytomegalovirus in the body of a pregnant woman were, then events develop somewhat differently. An exacerbation of an old cytomegalovirus infection, which can occur during pregnancy due to a weakened immune system in a pregnant woman with concomitant diseases or taking immunosuppressive drugs, also affects the fetus. But in this case the risk congenital cytomegaly in a child is lower than in the case of a primary infection, since the antibodies produced by the mother's body during the mother's latent virus carrier weaken the cytomegalovirus. And in this case, infection of the fetus occurs much less frequently - only in 1-2% of cases, and the consequences of infection are not so catastrophic.

As for the body of the pregnant woman herself, then acute form of cytomegalovirus infection may present with mild flu-like symptoms, low fever, and general malaise, which are quite common with many other respiratory infections. However, most often in a pregnant woman, cytomegalovirus infection is asymptomatic and latent cytomegalovirus can only be detected using . An accurate diagnosis in this case is made by blood test for intrauterine infections, where in addition to IgG to cytomegalovirus(characteristic of carriage), will be determined and IgM("fresh" immunoglobulins that appear only in an acute process).

A pregnant woman with an acute form of cytomegalovirus infection or with a primary infection is prescribed antiviral drugs and immunomodulators.

If treatment is started in a timely manner, the risk of infection of the child can be minimized. If a pregnant woman is a passive carrier of cytomegalovirus , then no treatment is prescribed for her, but it is recommended to make additional efforts to maintain normal immunity. If a child is born with a congenital form of cytomegaly, it is recommended to plan the next pregnancy no earlier than in 2 years.

Until now, our state considers that cytomegalovirus infection is considered a rather rare disease in pregnant women, and analysis for antibodies to cytomegalovirus are not included in the general program of examination of pregnant women. Therefore, in order to secure your pregnancy, you need to be conscious and spend some money - go through tests necessary when planning a pregnancy.

During pregnancy, a woman's immune system is weakened and subject to many trials. The degree of infection by any type of infection increases many times over. Microorganisms become a threat to the health of the baby, since the risk of infection through the placenta is very high. Of particular danger is the cytomegalovirus.

What is cytomegalovirus

Cytomegalovirus is a disease caused by a type of herpes virus. A sick person becomes the source of infection.

According to statistics, 95% of the population, regardless of place and living conditions, are carriers of this virus.

Doctors say that once infected, it is impossible to get rid of the infection. Despite such an extensive distribution, cytomegalovirus has been identified relatively recently. It was first isolated and described in detail by Margaret Smith in 1956.

Almost every person is a carrier of cytomegalovirus infection - the virus successfully disguises itself as a cold

In people with strong immunity, the microorganism does not cause complications. However, for pregnant women, cytomegalovirus infection poses a serious danger.

Depending on the period of pregnancy at which infection occurred, various scenarios are possible:

• if the infection happened in the early stages, up to 12 weeks, this often leads to the death of the fetus (miscarriage, miscarriage, stillbirth);
• with late infection, the child is born with a congenital infection. This can cause various anomalies: heart failure, mental disorders, dropsy of the brain;
• in some cases, asymptomatic development of the disease occurs, no consequences for the fetus are detected. The likelihood of developing a healthy baby is quite high. After birth, the child becomes a passive carrier of the virus, like most people who have been infected for a long time and are unaware of it. It is possible that the baby will be born with a low weight, but with age he catches up with his peers and develops normally;
• if the fetus was infected from the mother in the third trimester, the baby has every chance of surviving. In addition, pathologies of further development are often not observed. However, a woman has polyhydramnios, childbirth, as a rule, is premature;
• with an exacerbation of infection in a future mother, the risk of congenital cytomegaly in a child is significantly reduced. The fact is that the antibodies that the mother's body produces weaken the viruses, and infection of the fetus occurs only in 2% of cases.

In most cases, a viral infection is asymptomatic at all stages of pregnancy.

Video: Cytomegalovirus during pregnancy

Causes and ways of infection

Cytomegalovirus infection is called "kissing disease". This happens because the microorganism is not only in the patient's blood, but also in saliva and other secretions (vaginal, urine, semen, tears). Infection is possible with a weakened immune system.

Ways of infection do not differ from other viral infections:

• airborne (with sputum and saliva);
• contact - with kisses, breastfeeding;
• sexual - sexual contacts;
• intrauterine - through the placenta from mother to fetus;
• through blood (transfusion, use of unsterilized equipment).

Most often, infection occurs during sex, since semen and vaginal fluid contain the highest concentration of infection.

Important! Infection of the fetus is noted in 50% of cases during the initial infection. There are no antibodies in the woman's blood, which allows the microorganism to freely cross the placenta.

Cytomegalovirus does not appear immediately, this requires the creation of certain conditions:

• stressful situation;
• hypothermia;
• exacerbation of concomitant diseases;
• taking medications that suppress the immune system.

According to the international classification, two forms of the disease are distinguished:

• congenital - infection occurs in the prenatal period from mother to fetus;
• acquired - infection is possible at any age.

Depending on the manifestations, the following forms of the disease are distinguished:

• acute;
• chronic;
• latent (hidden);
• generalized - internal organs are affected, it is rare and is very difficult.

Symptoms

After the virus enters the body, the incubation period begins, which lasts from 20 to 60 days. Then comes the acute phase of the disease. This period lasts 2-4 weeks, and its duration depends entirely on the person's immunity.

Important! According to statistics, 90% of cases of cytomegalovirus infection proceed in a latent form without obvious signs.

Symptomatic manifestations depend on the form of the disease.

Acute phase

In women with a strong immune system, the disease in the acute period passes with mild malaise, fever up to 37 ° C, and headache. Sometimes a whitish coating appears on the tongue - this is a typical sign of cytomegalovirus. After 2-3 weeks, the condition returns to normal. After that, the infection subsides and manifests itself only when the immune system is weakened.

With a weak immune system, the following symptoms are noted:

• proliferation of lymph nodes - first, inflammation of the cervical glands is noted, then the inguinal, axillary and submandibular glands increase. Knots can reach a size of 5 cm;
• chills;
• a sharp increase in temperature;
• headache;
• disorders of the gastrointestinal tract;
• rhinitis;
• enlargement of the liver and spleen;
• decreased appetite.

According to clinical manifestations, the acute form of cytomegaly resembles infectious mononucleosis, but with cytomegalovirus there are no signs of angina. In addition, in laboratory diagnostics, a blood test for the detection of certain cells (Paul-Bunnel reaction) shows a negative result.

Acute cytomegalovirus syndrome leads to serious pathologies, so it is important not to delay treatment and seek medical help in a timely manner.

Generalized form

It is extremely rare. In most cases, it develops in patients with immunodeficiency or against the background of other diseases.

With a generalized form, a lesion occurs:

• lungs - the walls, tissue and capillaries near the lymphatic vessels are affected. The disease is difficult to treat;
• liver - the organ increases, an inflammatory reaction occurs, partial cell necrosis (necrosis) is noted. As a result, jaundice, liver failure develops;
• retina - photophobia appears, vision deteriorates, the patient feels flashes before his eyes. The choroid of the eyes is often affected, leading to blindness;
• salivary glands - salivation decreases, the patient feels dry mouth, the parotid glands become inflamed;
• kidneys - microorganisms can also affect the bladder and ureter. A precipitate appears in the urine, blood, which indicates renal failure;
• reproductive system - in women it manifests itself in the form of pain in the lower abdomen, pain during intercourse and urination.

Important! The generalized form of the disease in terms of the number of deaths is ranked second after influenza and acute respiratory infections.

In most cases, cytomegavirus infection manifests itself as a common cold, more serious symptoms are rarely diagnosed.

Diagnostics

The main method for determining infection is a blood test for antibodies (immunoglobulins):

• protective protein IgM - indicates an acute infection, appear already 1-2 weeks after the first infection, remain in the blood for up to 20 weeks. If the result indicates a positive reaction, it means that a primary infection or a transition from the latent phase to the active one has occurred. In this case, intrauterine infection is possible. To determine the level of antibodies, it is necessary to take tests every 2 weeks.

A negative result means that the infection occurred a long time ago, there is no acute form of the disease, so intrauterine infection is unlikely.

• IgG - detected during an exacerbation of the disease, as well as a latent course. It is not the fact of detection of these immunoglobulins that is important, but the avidity index (the degree of strength of the antigen-antibody connection). After infection, the level of avidity is low, in the future it increases.

Deciphering the results - table

Important! Tests for the presence of immunoglobulins are mandatory during pregnancy. It is recommended to take them no later than 10 weeks.

Additionally, the following diagnostic methods are prescribed for the detection of cytomegalovirus:

• general analysis of blood and urine - an increased level of leukocytes (white blood cells) is detected. The study does not give a complete picture of the nature of the development of the virus, with a positive result, it is recommended to undergo a full examination;
• biochemical blood test - shows the functioning of all organs and systems. Blood is taken from a vein. One of the indicators of physicians is the pigment bilirubin, a product of the breakdown of hemoglobin, which is formed in the liver. A pigment concentration above 3.4 mmol / l indicates an infectious lesion of the liver, which is caused by cytomegalovirus;
• PCR analysis of urine and blood - using a polymerase chain reaction, the DNA of a microorganism is detected. The advantage of the method is that its insignificant presence is sufficient to detect an infection. The probability of determining cytomegalovirus reaches 95%. The study is carried out quickly, with its help both acute and latent forms of the disease are revealed;
• cytological examination of urine or saliva (smear from the oral cavity) - the material taken is placed in a special environment, then giant cells are isolated under a microscope. Microorganisms, getting into a healthy cellular structure, destroy it. The cell is saturated with fluid and grows to a huge size. This structure is characteristic only for this type of virus, which allows you to confirm the diagnosis.

Treatment of the disease during pregnancy

Therapy is reduced only to the suppression of infection. Unfortunately, a tool has not yet been developed that will help to completely get rid of cytomegalovirus.

If the process proceeds calmly, without exacerbation, the doctor may prescribe drugs that can support the immune system:

• vitamin preparations;
• immunostimulants - Dibazol, Splenin;
• herbal teas - based on chamomile, rose hips, viburnum.

With severe clinical manifestations, doctors prescribe medications that can suppress the infection and “drive” it into a safe form:

• antiviral agents - Acyclovir (intravenous drip);
• immunocorrectors - Cytotect in the form of a dropper (3 times a day / day), in the II and III trimester, the use of the drug Viferon is allowed (suppositories rectally for 10 days);
• solution of furacilin or ethonium for oral treatment;
• Oxolinic ointment for lubrication of mucous membranes. The agent is applied 2 times a day, the course of therapy is no more than 25 days.

Recently, the use of glycyrrhizic acid has become widespread. Studies have not revealed adverse reactions during the period of gestation, however, it is not recommended to use the remedy on its own. The dosage is prescribed only by the attending physician.

Medications in the photo

Possible complications and consequences

Most women have been ill with cytomegalovirus infection long before pregnancy. In this case, the child is practically not in danger.

In 6% of women, infection occurs already during the bearing of the baby. In case of primary infection of the mother, in 50% of cases infection of the fetus is also observed.

The risk of damage increases significantly if infection occurs early (up to 12 weeks). In this case, a miscarriage, sudden birth is possible.

Infection in the second or third trimester can lead to the development of serious malformations in the infant, such as:

• jaundice;
• inguinal hernia;
• enlargement of the spleen and liver;
• neurological disorders;
• malformations of the central nervous system (dropsy of the brain, microcephaly and vascular necrosis are observed in 16% of children).

If serious anomalies in the development of the fetus are detected, a woman may be recommended to terminate the pregnancy at any time.

In 99% at birth, no clinical manifestations of the disease are detected. However, later in 10% of children there is a developmental delay. It should be borne in mind that 90% of babies with a congenital infection will be absolutely healthy.

90% of children with congenital cytomegalovirus infection develop absolutely normally, 10% have serious health problems

Preventive measures

Pregnant women should take the following precautions:

• avoid contact with patients, do not be in crowded places;
• observe the culture of sexual relations - avoid casual relationships, use a condom for any type of sex;
• carry out regular cleaning, maintain an optimal level of humidity in the room;
• observe the rules of personal hygiene;
• strengthen immunity - take walks in the fresh air, carry out hardening procedures, take vitamin-containing preparations. A strong immune system will help keep cytomegalovirus in an inactive form;
• if pregnancy is only planned, you should be screened for the virus in advance. Analyzes are taken by both sexual partners;
• during the gestation of the fetus, it is necessary to regularly donate blood, as well as follow the recommendations of the doctor.

Important! Modern medicine does not stand still, and a technique has now been developed that involves the introduction of immunoglobulins into the mother's body in order to protect the fetus. The therapy has proven itself well and is used as a prophylaxis for the congenital form of cytomegaly.

What is known to almost every person who has had a cold, and this is almost the entire population of the planet. The "accumulation of bubbles" on the lips is considered something very simple and ordinary, which will pass by itself and without a trace. But the herpes virus has many dangerous variations, one of which is cytomegalovirus infection. The detection of cytomegalovirus in pregnant women is a special and important topic, because there are already two organisms at risk - the expectant mother and her unborn baby.

What is it, how can you get infected, what are the symptoms of the disease, how dangerous is it for the child, and how to protect yourself from its serious consequences - these are the main questions that we will try to answer in this article.

Features of the disease

Cytomegalovirus (CMV) is one of the representatives of the herpes viruses. It is included in the group of TORCH infections along with such diseases as rubella, toxoplasmosis and herpes itself. This four has a negative impact on pregnancy, as well as on the condition of the fetus during fetal development and after the baby is born. The presence of cytomegaly was noted according to various statistics in 40-60% of the world's population.

There are such types of the course of the disease in pregnant women and children:

• latent (hidden, asymptomatic). This type of cytomegalovirus flow occurs in people with strong immunity, when the virus does not give clinical manifestations and is in a dormant state. This is called being a carrier. It passes into a reactivated form only with a decrease in the body's defenses. Pregnancy is one such condition;
• mononucleosis-like CMV is characteristic of persons with weak immunity. The symptoms look like a common cold. As a rule, it does not pose a danger, since the body still copes with this “infection”. But CMV does not disappear from the body, but simply after the symptoms disappear, it again becomes inactive and hidden;
• cytomegalovirus hepatitis is extremely rare. The signs resemble a viral disease of the same name: jaundice develops, the color of feces (urine and feces) changes, low temperature and deterioration in general condition. Within a week, the signs begin to disappear, and the disease turns into chronic CMV;
• generalized cytomegalovirus is characterized by a very severe course. With this form, almost all vital organs and systems are affected. It affects children under three months of age, infected in utero, persons with immunodeficiency. Similar manifestations are possible in those patients who underwent a transfusion of blood or its components or transplantation of organs and tissues.

Why is the problem of cytomegalovirus in pregnancy being considered? It is during this period that the immunity of the expectant mother decreases due to absolutely understandable physiological reasons. The so-called "preserved reaction" is triggered, when the immune response is reduced in order for the fetus to develop. In the early stages, it is perceived by the body as a foreign agent. If it were otherwise, mankind simply would not be able to reproduce their own kind, and each pregnancy would end in a miscarriage.

Before we panic about CMV and pregnancy, let's go over everything a mom-to-be and dad-to-be need to know about this highly dangerous infection.

How can a woman or child get infected

There are several ways to become infected with cytomegalovirus in children and adults, among them:

• In everyday life, infection does not occur so often, but it is quite possible. The infection outside the human body lives for a short time, and for infection it must be active. But you can get infected through kissing with carriers, using common personal hygiene items, utensils.
• The sexual route is the most common. So during conception there is a risk of "inheriting" cytomegalovirus, which can cause many pathologies both during pregnancy and after the birth of a child.
• The transfusion method remains also likely, although it occurs in very rare cases. With the development of modern medicine, it is possible to become infected during blood transfusions and organ transplants, but it is extremely rare.
• Placental method - the transmission of pathology from mother to fetus in utero. The virus passes through the placental barrier and infects the baby.
• Breastfeeding is one of the causes of infection of the child.

The highest risk of infection of the baby appears during the primary infection with cytomegalovirus during pregnancy. The presence of antibodies to CMV in a woman even before the child is planned suggests that the effect on the fetus will be minimal or not at all. Such mothers give birth to healthy babies, who are carriers in 85-90% of cases.

What can be the symptoms in women in position?

Cytomegalovirus infection during pregnancy is similar in symptoms to a common cold and therefore does not cause much concern for both the mother herself and her doctor. If a woman’s body is strong, then the immune response will “silence the virus”, that is, go into an inactive form. Or mild symptoms of ARI may be present:

• body aches;
• a slight increase in temperature;
• runny nose;
• sore throat;
• enlarged lymph nodes;
• headaches, as a sign of general intoxication.

Read also related

Types of tests for cytomegalovirus (CMV) and their interpretation

The difference is that an ordinary cold goes away within a week or two, while cytomegalovirus during pregnancy manifests itself with uncomfortable symptoms for up to 8 weeks.

Less commonly, the virus shows itself in the form of a mononucleosis-like form with the corresponding signs (high temperature, severe head pain). It is extremely rare that a generalized form develops, which is of particular danger, since it affects the entire body, the infection strikes many organs and systems of the body.

Diagnostic measures

When planning a pregnancy, a married couple is advised to diagnose for cytomegalovirus before such a crucial step.

To detect CMV during pregnancy, a whole range of measures is used. Each of them makes it possible not only to determine its presence in the mother's blood, but also to calculate the risks for the unborn baby.

• A serological blood test determines the presence of antibodies to CMV. The IgG immunoglobulins present in the results indicate that the woman has long been infected and antibodies to cytomegalovirus have been developed. IgM immunoglobulins are an indicator of primary infection. The absence of antibodies of both groups is a complete norm, but a woman is included in the “risk group”, since there are no antibodies in the body and the possibility of primary infection is high. In babies born to infected mothers, this analysis is regularly performed for the first four months to detect immunoglobulins. If IgG is detected, then the diagnosis of congenital cytomegaly is removed, but if IgM is evidence of an acute stage of pathology.
• PCR (polymerase chain reaction). Any body fluids can be used for research. The analysis makes it possible to detect the presence of cytomegalovirus DNA. If it is present, the result is positive.
• Bakposev. An analysis in which a smear from the vaginal mucosa is usually used, but variations are possible. Using this method, not only the presence of an infection is detected, but its condition (primary infection, remission, reactivation).
• Cytological examination consists in examining the urine or saliva of the patient under a microscope. When a virus is found in the body, its giant cells will be visible.
• Amniocentesis. The method of studying amniotic fluid is considered the most accurate, allowing to detect infection of the fetus with cytomegalovirus in the womb. This procedure can be carried out only after 21 weeks of pregnancy. But at least 6 weeks must pass from the moment of the alleged infection, otherwise the result will be false negative. The absence of the virus indicates a healthy baby. If it is detected, then other tests are prescribed to determine the concentration of CMV (viral load). The higher it is, the worse the consequences for the fetus can be.

An analysis for CMV, which gave a positive result, is not yet a sentence for either the mother or the unborn baby. Many children born with cytomegalovirus are completely healthy and never feel its effects in their lives. But in some cases, quite serious consequences are possible.

What is the danger of pathology

Cytomegalovirus is not always dangerous for a future mother and her baby, but there are certain risks of complications. Everything is determined by the time when the virus entered the body of a woman - before or after the conception of a child. If this happened long before pregnancy, then there are already response mechanisms in the blood - antibodies to the virus have been developed. This is the case when the possibility of getting a problem is minimal. CMV "sleeps" and, most likely, will not disturb either the mother or her child.

But there are about 2% of cases where a relapse occurs during pregnancy. Then they talk about a possible tarnaplacental infection, and the baby is born with CMV (congenital cytomegalovirus infection). Such an exacerbation requires complex treatment in order to avoid possible serious pathologies.

Especially dangerous is the primary infection with cytomegalovirus in the first trimester. Under such a combination of circumstances, it is impossible to predict the further course of pregnancy, the development of the child in the womb and after birth. But the scenarios for further events are not at all rosy:

• fading of pregnancy, fetal death, premature birth due to placental abruption, miscarriages in the early stages;
• the cardiovascular system suffers, congenital heart defects occur;
• microcephaly or hydrocephalus;
• serious organic pathological conditions of the central nervous system;
• mental retardation of varying severity;
• in the future, a lag in development, both physical and mental;
• deafness or hearing loss from birth;
• blindness or low vision from birth;
• lesions of the musculoskeletal system;
• an increase in the size of internal organs;
• frequent hemorrhages in the internal organs.

In some cases, when "brothers in the TORCH company" join the CMV, all further pregnancies will end in failure. Often there are miscarriages in the early stages. Therefore, we plan to conceive - we go through an examination for TORCH infection together with our spouse.

Congenital CMV

But let's calm the nerves of a pregnant woman a little. They are already shattered by her, for obvious reasons. It's not all that scary. Let's look at specific numbers.