Cytomegalovirus in pregnancy

Cytomegalovirus during pregnancy is a fairly common infection that is found in many women. Let's consider the main causes of cytomegalovirus infection, symptoms and what danger it poses during pregnancy.

CMV or cytomegalovirus infection belongs to the group of herpes infectious microorganisms. Most often it appears in people with the immunodeficiency virus and in pregnant women. The main danger of the infection is the serious consequences and complications that it can cause. According to medical statistics, about 1% of newborns are infected by the mother. In some children, CMV is not accompanied by painful symptoms, but the infection can cause congenital diseases that manifest themselves in the first months of the child's life.

Statistics say that out of 1000-750 children, one has CMV, which is congenital or develops after birth. The congenital form of cytomegalovirus can be acute or chronic. But acquired CMV can be latent, generalized and acute mononucleosis-like. The incubation period is still unknown, diagnosis is complicated by the unexpressed clinical picture. In medical literature, a period of 20-60 days is indicated before the first symptoms of cytomegalovirus appear.

• If a person has a normal immune system, the disease takes a latent form. That is, the infection can remain in the body for many years and not make itself known until the immune system reduces its protective properties. One of the reasons for reduced immunity is pregnancy.
• Mononucleosis-like CMV occurs in pregnant women with a weakened body. The main signs of infection are weakness, fever, muscle pain, chills, and enlarged lymph nodes. Most often, the disease does not have serious consequences for the body, since the immune system's protective properties cope with the pathogen and the cytomegalovirus goes into a latent state.
• Cytomegalovirus hepatitis is very rare. This form of the disease causes yellowing of the skin and sclera, changes in the color of urine and stool. In addition, biochemical signs of the disease are observed, namely an increase in liver enzymes. The acute course of the infection passes in a week and takes a latent form.
• Generalized form, occurs in children under three months, patients with the immunodeficiency virus, and after organ transplants or blood transfusions. The disease is very severe, causing damage to the lungs, kidneys, gastrointestinal tract and nervous system.

Very often CMV occurs simultaneously with acute respiratory infection. The main symptoms are general malaise, increased fatigue and weakness, low temperature, runny nose and sore throat. If a woman has had CMV during pregnancy, then intrauterine infection occurs. But, despite this, only 5% of fetuses suffer from cytomegalovirus.

All cases of congenital infection are considered dangerous. If a woman has suffered from cytomegalovirus infection in the early stages of pregnancy, it can lead to the death of the fetus and spontaneous abortion. In the later stages of gestation, congenital CMV infection leads to hemorrhagic syndrome, which is accompanied by hemorrhages in tissues and internal organs. Sometimes, congenital infection manifests itself several years after the birth of the baby. The child develops hearing impairment and developmental delays. Fibrosis of internal organs and motor disorders are possible. The main feature of cytomegalovirus infection is that it manifests other lesions of the newborn's body: immunodeficiencies, hemolytic disease, and others.

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Causes of cytomegalovirus during pregnancy

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

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

45% of people in the world have antibodies to CMV infection, that is, they are seropositive. The older a person is, the higher the probability that he or she has immunity to cytomegalovirus. In Switzerland, about 45% of the population is seropositive to the infection, in Japan about 96%, and in Ukraine from 80-90%. Primary CMV appears at 6-12 years, that is, in childhood. In this case, the infection can be latent, that is, it can enter the child's body during breastfeeding, during passage through the birth canal, etc. The causes of cytomegalovirus during pregnancy are varied, since the infection can be in the blood, sperm, urine, saliva, tears, and even in vaginal secretions.

How does cytomegalovirus affect pregnancy?

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

The disease is very dangerous, since if the fetus is infected intrauterine, it can lead to its death or various disorders in the development of systems and organs. Infection of the embryo can occur during conception, through sperm. But most often, infection occurs during childbirth, when passing through the birth canal. In this case, intrauterine infection is much more dangerous for the fetus, unlike infection through breast milk.

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

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

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

• Ultrasound examination

Allows to identify fetal developmental abnormalities caused by cytomegalovirus: microcephaly, intrauterine growth retardation, ascites, oligohydramnios, and brain developmental abnormalities.

• Amniocentesis

This examination is an analysis of amniotic fluid. The method is considered one of the most effective for detecting intrauterine CMV. The study is possible from the 21st week of pregnancy, but not earlier than 6-7 weeks after the suspected infection. If the analysis is negative, we can say that the child is healthy. If the analysis is positive, then the woman undergoes a quantitative PCR analysis for cytomegalovirus. In this case, the higher the viral load, the worse the prognosis for pregnancy. Let's consider the possible results of the study:

• The amount of cytomegalovirus DNA <10*3 copies/ml – 80% probability that the future child is healthy.
• The amount of cytomegalovirus DNA ≥10*3 copies/ml – 100% probability that the virus has entered the fetus’s body.
• Cytomegalovirus DNA count <10*5 copies/ml – 90% probability of absence of CMV symptoms in a child at birth.
• The amount of cytomegalovirus DNA ≥10*5 copies/ml – there is a high probability of the birth of a child with symptoms of congenital CMV and pathologies caused by the virus. In this case, the doctor may prescribe termination of pregnancy.

But there is no need to panic in advance, since not always a child infected with cytomegalovirus has health complications. All children with CMV are under constant dispensary observation. However, in some cases, the virus, having affected the fetus in the womb, causes its death. Some infected newborns begin to have serious pathologies in physical and mental development.

Symptoms of cytomegalovirus during pregnancy

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

• In women, cytomegalovirus causes cervical erosion, inflammation of the fallopian tubes and ovaries, and cervicitis. The inflammatory process can affect the ovaries, accompanied by severe pain in the lower abdomen and whitish-bluish discharge. In pregnant women, the infection can be asymptomatic.
• In men, CMV causes cold symptoms, which are accompanied by inflammation of the genitourinary system. Diseases of the urethra and testicular tissue may worsen. Due to cytomegalovirus, a man feels pain and discomfort when urinating.
• Let's consider the general symptoms of cytomegalovirus during pregnancy, which are usually determined using differential diagnostics:
• Acute respiratory viral infection - a woman complains of weakness, increased fatigue and general malaise, frequent headaches, inflammation of the salivary glands, increased sweating, a whitish coating on the tongue and gums.
• Lesions of the genitourinary system – symptoms of a chronic non-specific inflammatory process appear. If doctors fail to establish the viral nature of the pathological symptoms, antibiotic therapy is administered, which, as a rule, does not give the expected results.
• If a woman has a generalized form of cytomegalovirus infection, it is accompanied by damage to the internal parenchymatous organs. Most often, inflammation of the adrenal glands, kidneys, pancreas, and spleen occurs. Because of this, seemingly causeless bronchitis and pneumonia become more frequent, which are poorly treated with antibiotics.
• Cytomegalovirus infection is accompanied by a significant decrease in the immune status, a decrease in platelets. Damage to the intestinal walls, peripheral nerves, eye vessels and the brain is possible. Cases of enlargement of the submandibular and parotid salivary glands, skin rash and exacerbation of inflammatory diseases of the joints are not uncommon.

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

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

Consequences of cytomegalovirus during pregnancy

The consequences of cytomegalovirus during pregnancy can be fatal for the child. That is why every woman should undergo a CMV test before conception. This will help find out whether there is any reason to be afraid or whether it is enough to simply strengthen the immune system. The consequences can make themselves known both in the case of primary cytomegalovirus infection and in the case of transplacental infection.

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

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

Cytomegalovirus during pregnancy can become a serious danger to the health of the child. The probability that the virus will lead to the above-described consequences is 9%, and with primary CMV or its reactivation 0.1%. That is, many women who were diagnosed with cytomegalovirus infection during pregnancy give birth to absolutely healthy children.

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Diagnosis of cytomegalovirus during pregnancy

Cytomegalovirus diagnostics during pregnancy should be carried out at the stage of conception planning. To detect the virus, blood, urine, saliva, scraping and smear from the genitals are tested. During pregnancy, CMV is detected using a blood test. It is difficult to diagnose the infection due to the unclear clinical picture. Therefore, tests are carried out to detect antibodies. If the analysis reveals the presence of specific antibodies to CMV, this indicates the presence of the virus in the body.

The main methods for diagnosing cytomegalovirus:

• Cytological – reveals enlarged cells in breast milk, urine sediment, saliva and other secretory fluids.
• Serological – cytomegalovirus antibodies are detected using immunoglobulins IgG and IgM. If IgM is detected in a pregnant woman, this indicates a recent infection, which requires detailed study. An analysis of the umbilical cord blood of the embryo is performed to detect immunoglobulins. If the analysis shows IgM, this indicates that the child is infected with CMV.
• Molecular biological – performed to detect cytomegalovirus DNA in the body’s cells.
• Virological is a rather expensive and labor-intensive diagnostic method. To perform it, the pathogen is cultivated on its nutrient medium.

Of all the above diagnostic methods, the serological one is most often used. If there are antibodies to cytomegalovirus in the blood, i.e. igg is positive, then this indicates high immunity in the pregnant woman. In most cases, CMV is latent.

If the cytomegalovirus test is negative, pregnant women are recommended to undergo testing every trimester, as expectant mothers are considered to be at risk. In any case, the absence of antibodies is a potential threat to a normal pregnancy. Babies born to a sick mother must undergo diagnostics in the first days of life for the presence of antibodies. However, if IgG antibodies were detected in a newborn in the first three months, this is not a sign of congenital cytomegalovirus. But the presence of IgM indicates acute CMV.

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Cytomegalovirus test during pregnancy

Cytomegalovirus testing during pregnancy is mandatory for every expectant mother. This is because CMV infection in the first 20 weeks of pregnancy can lead to miscarriage and fetal death. But cytomegalovirus is also very dangerous in the last months of pregnancy. Therefore, to avoid serious consequences of the disease, every woman takes a cytomegalovirus test.

Laboratory diagnostics of CMV consists of urine and saliva tests, polymerase chain reaction, and serological testing of blood serum. Let's consider each of the tests in more detail.

• Cytological studies of urine and saliva sediment

The pregnant woman's urine and saliva are examined under a microscope to detect the characteristic huge cells of CMV.

• PCR or polymerase chain reaction

The diagnostics are based on the determination of the infection DNA, which is contained in viral cells and is the carrier of hereditary information in blood cells. Urine, scrapings, sputum or saliva are used to perform PCR.

• Serological tests of blood serum

The analysis is performed to detect antibodies specific to CMV in the blood. Today, the most accurate is the enzyme immunoassay (ELISA). With the help of such an analysis, it is possible to determine different types of immunoglobulins IgG, IgM and their avidity.

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Cytomegalovirus norm during pregnancy

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

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

Indicators		Avidity	Decoding the results
IgM-	IgG-	They don't define	Seronegativity, the virus is absent in the female body. Nothing threatens the normal development of the fetus.
IgM+	IgG-/+	Low	There is primary CMV infection and a risk of infection of the fetus.
IgM+/-	IgG+	Threshold zone (average values)	The primary infection is in its final stage and the risk of infection of the fetus is high.
IgM-	IgG+	Tall	Cytomegalovirus is in a latent state, the risk to the fetus is minimal.
IgM+/-	IgG+	Low	CMV in the reactivation stage, high risk of infection of the fetus.

IgG within the normal range and the absence of IgM are considered normal. Such results indicate that the female body has never been in contact with the virus. If IgG is above the norm, and there is no IgM, then the woman's body contains the virus in a latent state. In this case, in the presence of provoking factors and a weakened immune system, the probability of infection of the fetus in the womb or the child during the birth process is minimal. If IgM is above the norm, then the woman has experienced primary infection, but pregnancy can trigger the virus again and cause intrauterine infection of the fetus.

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

IgG to cytomegalovirus during pregnancy

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

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

• IgG to cytomegalovirus during pregnancy allows confirming primary infection. During primary infection, IgG antibodies in the blood appear later than IgM and are characterized by low avidity.
• The study of IgG antibodies is part of a complex of laboratory tests for TORC infections. In addition to cytomegalovirus, a woman is tested for herpes infection, rubella, and toxoplasmosis.
• All children aged six months and older have IgG antibodies in their blood that are of maternal origin. This makes the interpretation of IgG avidity results difficult.
• If a woman has immunodeficiency, the level of antibodies is very low and cannot be detected in the blood. Other biological fluids are used for diagnostics and PCR is performed.

Cytomegalovirus IgG positive in pregnancy

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

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

The body's defense reaction is based on the production of IgM and IgG antibodies, which are responsible for the lysis and replication of intracellular cytomegalovirus. Cytomegalovirus IgG has average normal values in IU/ml. So, if the value is greater than 1.1, this indicates the presence of an infection in the body. If the value is less than 0.9, the result is negative, that is, the woman and the normal course of pregnancy are not threatened.

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IgM to cytomegalovirus during pregnancy

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

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

• Presence of symptoms – if there are no symptoms of infection at all, but CMV is detected in the analysis, then the pregnant woman is not prescribed antiviral drugs.
• Asymptomatic CMV indicates a high status of the immune system, which has independently dealt with the infection. In order to speed up the process of antibody production, the pregnant woman is prescribed immunomodulators and vitamins, which have general strengthening properties and increase immunity.
• If the symptoms of cytomegalovirus are pronounced, the woman undergoes antiviral treatment. Vitamin therapy is mandatory.

Cytomegalovirus IgM positive during pregnancy

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

A positive result for IgM and IgG indicates a secondary exacerbation of cytomegalovirus. At the same time, 90% of the population have a positive IgG result and this is considered normal. But if the test result is positive for IgM, women are not recommended to become pregnant until this titer is normalized. If the condition was diagnosed during pregnancy, a consultation with a gynecologist and medical intervention are required.

A certain amount of IgM is an indicator of cytomegalovirus activity. IgM indicates the severity of the infectious lesion, reinfection or reactivation. If a positive IgM is detected in a seronegative patient, this indicates the primary nature of the disease. IgM antibodies appear only with endogenous reactivation of CMV. Timely detection of antibodies allows for comprehensive monitoring, studying the dynamics of cytomegalovirus and its clinical manifestations. If CMV has taken a severe form in a pregnant woman, the production of antibodies slows down significantly. This also applies to people with a weakened immune system.

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Cytomegalovirus avidity in pregnancy

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

Indicators		Avidity	Decoding the results
IgM-	IgG-	They don't define	Seronegativity, the virus is absent in the female body. Nothing threatens the normal development of the fetus.
IgM+	IgG-/+	Low	There is primary CMV infection and a risk of infection of the fetus.
IgM+/-	IgG+	Threshold zone (average values)	The primary infection is in its final stage and the risk of infection of the fetus is high.
IgM-	IgG+	Tall	Cytomegalovirus is in a latent state, the risk to the fetus is minimal.
IgM+/-	IgG+	Low	CMV in the reactivation stage, high risk of infection of the fetus.

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

Avidity data is an important indicator of the stage of infectious development of cytomegalovirus. If avidity is below 30%, this indicates the spread of the virus throughout the body and primary infection. Avidity over 60% indicates a previous infection, i.e. the virus is in a latent state. Avidity at the level of 30-50% is a repeated infection or cytomegalovirus is in an active stage.

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Cytomegalovirus in a smear during pregnancy

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

The danger of cytomegalovirus detected in a smear in a pregnant woman is that the infection can cause a complex disease - cytomegalovirus. In women with a healthy immune system, even if they are carriers of CMV, the virus is latent and does not manifest itself. In this case, when taking a smear, antibodies to type V herpes will be detected. If the virus is not activated during pregnancy or during the birth process, the fetus will not become infected, that is, the child is not in danger.

• The risk of infection occurs when the pregnant woman's body is exposed to stress. The cytomegalovirus can be reactivated by the woman's bad habits, which negatively affect her health.
• Various chronic diseases and pathologies, long-term treatment or therapy that weakens the immune system pose a risk of CMV infection. Infection of the child will inevitably occur, since the already weakened immune system of the woman will not be able to suppress the virus. Symptoms of cytomegalovirus are similar to ARVI, only the duration of the respiratory infection lasts at least 5-6 weeks.
• Cytomegalovirus is most dangerous in the first trimester of pregnancy. Since during this period the infection can provoke a miscarriage. If CMV is reactivated in the last stages of pregnancy, placental abruption, frozen pregnancy or premature birth are possible.

But the presence of cytomegalovirus does not always mean that the child will be infected. It depends on the behavior of the pregnant woman, in whose smear CMV was found. The woman must follow the doctor's instructions and adhere to all recommendations. As a rule, the woman is prescribed antiviral medications and immunomodulators. The expectant mother is required to closely monitor her health, maintain the immune system and eat healthy, balanced food. It is especially important for women who have cytomegalovirus in a latent state to comply with these conditions. If the expectant mother leads a healthy lifestyle and monitors her health, then there is a high chance that the child will be born healthy and without pathologies caused by cytomegalovirus.

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Cytomegalovirus DNA in pregnancy

Cytomegalovirus DNA during pregnancy is determined using scraping, which is a method of qualitative detection of CMV. The danger of the virus is that it can cause an infectious disease - cytomegalovirus. This disease affects the salivary glands and forms giant cells with intranuclear inclusions in the tissues. Very often, infected women do not know about their condition, since the infection is latent.

• A distinction is made between generalized and localized forms of the disease caused by cytomegalovirus. In the localized form, pathological processes are detected only in saliva, while in the generalized form, changes affect all organs and systems.
• CMV belongs to a group of reproductively dangerous infections that are part of the TORCH complex (Toxoplasma, Rubella, Cytomegalovirus, Herpes). A TORCH examination is carried out six months before pregnancy in order to determine the state of the immune system of the expectant mother and, if necessary, to carry out immunotherapy and other therapeutic measures.

To diagnose cytomegalovirus DNA and assess the risk of developing a distinct form of CMV, special tests are used: anti-CMV-IgG and anti-CMV-IgM. Blood is used as the material for the analysis, and the PCR method detects viral DNA. If, according to the analysis results, a fragment of cytomegalovirus DNA is detected in a pregnant woman, this indicates infection. If DNA is not detected, this may indicate that there are no DNA fragments or that the biological material taken during the study contained an insufficient amount of cytomegalovirus DNA to conduct the study.

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Treatment of cytomegalovirus during pregnancy

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

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

Very often, CMV is accompanied by symptoms of ARVI and other concomitant diseases. In this case, the success of cytomegalovirus treatment depends on the effectiveness of the treatment of the resulting lesion. For this, antiviral and immunomodulatory drugs are used, in combination with drugs prescribed for the treatment of the disease. Self-treatment of cytomegalovirus is strictly prohibited. Since only a doctor can select a safe but effective drug.

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

Treatment of cytomegalovirus during pregnancy involves drug therapy. Let's consider the main drugs used for cytomegalovirus:

• Anti-cytomegalovirus human immunoglobulin

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

• Antiviral drugs

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

• Immunomodulators

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

Prevention of cytomegalovirus during pregnancy

Prevention of cytomegalovirus during pregnancy depends on the type and form of infection. There is no specific prevention or vaccination, so at the stage of pregnancy planning, a woman should be tested for CMV antibodies. Seronegative women (who do not have IgG antibodies) are advised to avoid potentially dangerous contacts: young children or a seropositive partner. If an infected woman gives birth to a child with intrauterine cytomegalovirus, then the next pregnancy can be planned no earlier than in 2 years.

The main method of prevention is to maintain personal hygiene. Since the spread of cytomegalovirus is possible through contaminated biological fluids that come into contact with hands and are absorbed through the mouth or nose. If a pregnant woman comes into contact with children, it is recommended to adhere to hygiene methods, from hand disinfection to changing diapers with gloves. Hand hygiene is an effective means of preventing the spread of the virus.

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

• Carefully observe the rules of hygiene, wash your hands regularly with soap.
• If you have mononucleosis, you must undergo mandatory testing for CMV.
• Do not use other people's cutlery or bed linen.
• Any form of herpes disease is an indication for testing for cytomegalovirus.
• To normalize CMV levels, it is recommended to drink herbal teas and carefully monitor your diet.

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

Cytomegalovirus prognosis during pregnancy

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

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

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