Detection of cytomegalovirus in pregnant women and its treatment. Cytomegalovirus during pregnancy: positive and negative results

Cytomegalo viral infection in most cases it occurs in a person in a latent or mild form. Cytomegalovirus is dangerous only for pregnant women. What should an expectant mother know about this disease?

Causes

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

Transmission of infection occurs from person to person in several ways:

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

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

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

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

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

Symptoms

For most people cytomegalovirus infection is asymptomatic. Development of complete clinical picture typical only for newborn children, as well as for people with congenital or acquired immunodeficiency. In the latent form of the disease, minimal symptoms similar to a common cold may appear.

Signs of CMV infection:

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

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

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

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

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

Cytomegalovirus often affects the pelvic organs. The disease is almost always asymptomatic and is detected only during laboratory examination. Signs of overt infection are not specific and are rarely diagnosed. It is possible that a viral infection may intensify during pregnancy and complications in the fetus may develop.

Complications of pregnancy and consequences for the fetus

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

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

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

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

Congenital cytomegalovirus infection

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

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

I trimester

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

If pregnancy continues, various developmental anomalies may develop:

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

In those infected in the early stages intrauterine development Children often develop generalized intravascular coagulation. Minor hemorrhages occur on the skin. There is a decrease in platelet levels, and disturbances in the hemostasis system occur. This condition can be very dangerous and requires mandatory assistance from specialists after birth.

Congenital CMV infection acquired in the early stages often leads to intellectual impairment in newborns. There may be no visible malformations of the brain. Slowing down of mental and physical development– one of the expected long-term consequences of congenital cytomegalovirus infection.

II trimester

Infection at 12-24 weeks rarely leads to the formation of congenital malformations of the fetus. Microcephaly and other brain changes are not typical. In some newborns, there is an enlargement of the liver and spleen, and the formation of foci of extramedullary (outside the bone marrow) hematopoiesis. Characterized by prolonged jaundice after birth, as well as various pathologies of the blood coagulation system. Many children are born without visible signs of infection.

III trimester

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

• enlarged liver and spleen;
• prolonged jaundice;
• hemorrhagic rash on the skin;
• hemorrhages in the mucous membranes, internal organs, brain;
• bleeding;
• progressive anemia;
• thrombocytopenia (decreased platelet levels in the blood).

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

The following complications arise against the background of congenital CMV infection:

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

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

Long-term consequences of congenital CMV infection:

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

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

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

In most cases, manifestations of CMV infection in the fetus occur against the background of a pronounced decrease in the mother’s immunity. Women with chronic diseases and those who received immunosuppressive therapy before conceiving a child are at risk.

Complications of pregnancy

Cytomegalovirus is the culprit of the following conditions:

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

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

Diagnostics

Two methods are used to detect cytomegalovirus:

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

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

Determination of antibodies and DNA of cytomegalovirus is carried out for all women when registering during pregnancy. According to indications, the doctor may prescribe a repeat test for later.

Fetal malformations are detected using ultrasound. If serious defects incompatible with life are detected, the question of terminating the pregnancy is raised. Induced abortion is done for a period of up to 12 weeks (up to 22 weeks - with special permission from the expert commission). The decision to terminate or continue the pregnancy remains with the woman.

Treatment methods

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

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

When latent CMV infection is reactivated during pregnancy, immunomodulatory therapy is performed. For this purpose, human immunoglobulin is used intravenously. The drug is administered three times during pregnancy in the 1st, 2nd and 3rd trimesters.

Treatment of CMV infection is carried out on an outpatient basis. Hospitalization is indicated only when the disease is generalized. According to indications, related specialists (immunologist, etc.) are involved in therapy.

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

Prevention

Nonspecific prevention of CMV infection includes:

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

All women planning pregnancy are recommended to undergo testing for CMV. If an infection is detected in the active phase, you must contact a specialist. The course of treatment outside pregnancy is 14-21 days. To treat CMV infection, specific antiviral drugs (ganciclovir, acyclovir, etc.) are used.

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

Cytomegalovirus during pregnancy poses a huge threat to the health of the woman carrying the baby, and especially the unborn child. The course of the disease is acute; due to the lack or absence of antibodies, the virus penetrates the placenta and infects the fetus. Why does cytomegalovirus infection occur in pregnant women, how does it manifest itself and what are the modern and effective ways her treatment?

What is cytomegalovirus?

One of the most common viral diseases is herpes. If the causative agent of such a disease enters the human body, it remains there permanently. Carriage of the virus is not dangerous: it does not lead to the appearance of clinical signs. If a person's immunity is weakened, symptoms of pathology may occur.

Cytomegalovirus belongs to the herpesvirus family. It became known about it in the middle of the last century. Due to the fact that they are formed immediately after contact with it, large quantity people are tested positive. They may not be aware of this, because the symptoms of the disease do not appear. They occur when the immune system is weakened.

After the pathogen is introduced into the body, all cell structures change, which is why they begin to grow in size. All women during pregnancy are at risk because their immunity is weakened.

There are such ways of transmitting the pathogen during the period of waiting for a child:

• sexual tract (CMV during pregnancy can enter the bloodstream during vaginal, anal, oral sex without the use of contraception);
• household route (cmv infection occurs less frequently - when using hygiene products, dishes, visiting public places);
• blood transfusion route (for pregnant women, cytomegalovirus is dangerous because it can enter during a blood transfusion from a donor, tissue transplantation, etc.).

This pathogen enters the baby’s body during development in the uterus, at the time of birth and during breastfeeding.

What are the signs of infection?

The virus does not manifest itself provided that a person has an active immune system. The disease occurs in a latent form. The weakening of the immune defense affects the activity of the pathogen, and it makes itself felt in various manifestations. Most often, pregnant women experience signs of an acute respiratory infection, including:

• hypothermia;
• fatigue;
• severe weakness;
• rhinitis;
• sore throat;
• inflammation of the salivary glands and their pathological enlargement;
• tonsillitis.

Women may mistake cytomegalovirus for an acute respiratory infection. The difference between the signs of this infection is that they can appear within a month, sometimes longer.

Mononucleosis-like syndrome is considered a rather rare complication of cytomegalovirus infection. Its exacerbation is manifested by a sharply elevated temperature, severe headache. The duration of the illness is up to 6 weeks.

With immunodeficiency, relapse often occurs. The disease occurs with numerous complications, including:

• pneumonia;
• pleurisy;
• joint inflammation;
• heart muscle disease;
• brain inflammation;
• vegetative-vascular disorders.

Generalized forms are extremely rare. The infection affects the entire body. The course of the disease is severe, with the following symptoms:

Cytomegalovirus and pregnancy are an extremely unfavorable and dangerous combination. While waiting for the baby, the patient must be attentive to her health and do everything to protect herself from a dangerous infection.

How dangerous is cytomegalovirus?

When the pathology is active, immunostimulants alone are not enough. Doctors have to prescribe antiviral drugs. Reactivated infections are also treated in the same way. Due to their high toxicity, the use of antiviral medications during pregnancy is limited and can only be justified if the benefits are much greater than the possible risks.

Specific anticytomegalovirus immunoglobulin is administered intravenously. Contains more than half of the antibodies specific to cytomegalovirus.

Immunoglobulin can also be administered intramuscularly, but this method is less effective. Using this medicine reduces the chance of fetal infection and reduces Negative consequences. This drug cannot completely “expel” the virus from the body. But even such treatment results provide a big gain in the fight against the infectious agent and help preserve the baby’s health.

Some nonspecific immunoglobulins are administered intravenously and are used to prevent infection. Their efficiency is much lower. Cytomegalovirus is insensitive to interferon, and its use during pregnancy is useless.

Such a pathogen can provoke concomitant pathologies, such as ARVI or pneumonia. When they appear, specific treatment is prescribed taking into account the duration of pregnancy. Self-prescribing any drug is strictly prohibited.

Prevention of infection

No specific prevention has been developed. There is also no specially created vaccine to prevent infection. When transfusing, it is recommended to use exclusively healthy donor blood that does not contain. For women at risk, the use of hyperimmune immunoglobulin is indicated.

Limiting contact between pregnant women and sick people is of great importance. In maternity hospitals, it is necessary to strictly observe the anti-epidemic regime. A child born to a mother with this infection cannot be kept on breastfeeding. He is transferred to artificial mixtures.

If a woman gives birth to a baby with an infection, a second pregnancy may occur no sooner than after 2 years. The following recommendations will help significantly reduce the likelihood of infection:

• It is necessary to wash your hands well with soap;
• Children under 5 years old should never be kissed on the lips;
• pregnant women and babies should have their own dishes;
• During pregnancy, it is advisable to limit contact with small children (this especially applies to women working in preschool institutions).

Cytomegalovirus cannot be safe during pregnancy. Every woman needs to be tested before conceiving a child to make sure there is no dangerous pathogen. If it is detected, it is necessary to be under the supervision of a specialist.

Almost every person who has had a cold (and this is almost the entire population of the planet) knows what herpes is. “Accumulation of bubbles” on the lips is considered something very simple and ordinary that will go away by itself and without a trace. But the herpes virus has many dangerous variations, one of which is cytomegalovirus.

What is cytomegalovirus, what danger does it pose, how can one become infected, what are the symptoms of the disease and how to treat it - these are the main questions that concern a person who has learned about such a diagnosis.

Detection of cytomegalovirus in pregnant women is a special and important topic. After all, there are already two organisms at risk - future mom and her unborn baby. How dangerous is it for a child, and how to protect yourself from its serious consequences?

Features of the disease

Cytomegalovirus (CMV) is one of the representatives of the herpes virus series. It is included in the group of TORCH infections along with diseases such as rubella, toxoplasmosis and herpes itself. These four provide Negative influence on pregnancy in particular, as well as on the condition of the fetus during intrauterine development and after the birth of the child.

The presence of cytomegaly is noted according to various statistical data in 40-60% of the world's population. Moreover, it can be congenital and acquired during life.

Characteristic signs of congenital pathology are acute or chronic. The following types of disease are noted:

• latent (hidden, asymptomatic). This occurs in people with strong immune reactions, when the virus does not produce clinical manifestations. This is called carrier status. It turns into a reactivated form only when the body’s defenses decrease. Pregnancy is one such condition;
• mononucleosis-like CMV is typical for individuals 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 becomes inactive and hidden;
• Cytomegalovirus hepatitis is an extremely rare phenomenon. The signs are reminiscent of the viral disease of the same name: jaundice develops, the color of stool (urine and feces) changes, low temperature and deterioration in general condition. Within a week, the signs begin to disappear, and the disease becomes chronic CMV;
• generalized 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, and people with immunodeficiency. Similar manifestations are possible in those patients who have undergone a transfusion of blood or its components or organ and tissue transplantation.

Why is the problem of cytomegalovirus being considered during pregnancy? It is during this period that the expectant mother’s immunity decreases due to absolutely understandable physiological reasons. The so-called “saved reaction” is triggered when the immune response decreases due to fetal development. In the early stages, it is perceived by the body as a foreign agent. If it were otherwise, humanity simply would not be able to reproduce its own kind, and every pregnancy would end in miscarriage.

Before you start panicking about CMV and pregnancy, let's look at everything that mom-to-be and dad-to-be need to know about this very dangerous infection.

Routes of infection

There are several ways to become infected with the virus in adults, but there are a few more ways to transmit it to a baby.

• In everyday life, infection does not occur so often, but it is quite possible. The infection lives outside the human body for a short time, but in order to become infected it must be active. But you can become infected through kissing carriers, using shared personal hygiene items and utensils.
• The sexual route is the most common. So during conception there is a risk of “passing on” a dangerous virus, which can cause many pathologies both during pregnancy and after the birth of a child.
• The transfusion method remains also possible, 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.
• The placental method is the transmission of pathology from mother to fetus in utero. The virus passes through the placental barrier and affects the baby to one degree or another, but further development of the event is influenced by factors.
• Breastfeeding is one of the causes of infection in a child. But with this method of transmitting the disease, the possibility of any complications and the development of pathological conditions in the child is extremely small.

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

Clinical picture

Cytomegalovirus infection during pregnancy is similar in symptoms to a common cold and therefore does not cause any particular concern either for the mother herself or for her attending physician. If a woman’s body is strong, then the immune response will “silence the virus,” that is, turn into an inactive form. Or there may be mild symptoms of acute respiratory infections:

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

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 manifests itself in the form of a mononucleosis-like form with corresponding symptoms (high temperatures, severe headaches). It is extremely rare to develop a generalized form, which poses a particular danger, since it affects the entire body; the infection affects many organs and systems of the body.

Diagnostic measures

A married couple is advised to conduct a diagnosis for cytomegalovirus when planning a pregnancy before such an important 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. IgG immunoglobulins present in the results indicate that the woman has been infected for a long time and antibodies have been developed. IgM immunoglobulins are an indicator of primary infection. The absence of antibodies of both groups is completely normal, but the woman is included in the “risk group”, since there are no antibodies in the body and the possibility of primary infection is high. For babies born to infected mothers, this test 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 acute stage pathology.
• PCR (polymerase chain reaction). Any biological fluids of the body 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.
• Bac sowing. An analysis that usually uses a smear from the vaginal mucosa, but variations are possible. Using this method, not only the presence of infection is detected, but its condition (primary infection, remission, reactivation).
• A cytological examination consists of examining the patient's urine or saliva under a microscope. When a virus is detected 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 in the womb. This procedure can only be performed after 21 weeks of pregnancy. But at least 6 weeks must pass from the moment of suspected 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 may be.

Giver positive result– this is not a death 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 the expectant mother and her baby, but there are certain risks of complications. Everything is determined by the time when exactly the virus entered the woman’s body - before or after conceiving a child. If this happened long before pregnancy, then the blood already has response mechanisms - antibodies to the virus have been developed. This is the case when the possibility of getting a problem is minimal. CMV is “sleeping” and, most likely, will not disturb either the mother or her child.

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

Primary infection is especially dangerous in the first trimester. Under such circumstances, it is impossible to predict the further course of pregnancy and 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, early miscarriages;
• suffers the cardiovascular system, arise birth defects hearts;
• microcephaly or hydrocephalus;
• serious organic pathological conditions CNS;
• mental retardation of varying severity;
• in the future, developmental delays, both physical and mental;
• deafness or hearing loss from birth;
• blindness or low vision from birth;
• lesions of the musculoskeletal system;
• increase in the size of internal organs;
• frequent hemorrhages in internal organs.

In some cases, when CMV is joined to “get together for TORCH companies,” all further pregnancies will end in failure. Miscarriages often occur in the early stages. Therefore, when we are planning to conceive, we, together with our spouse, are tested for TORCH infections. After all, transplacental infection is affected by the condition of not only the mother, but also the father.

Congenital CMV

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

With congenital cytomegalovirus infection, only in 10-15% of cases one or more of the following symptoms may occur:

• low birth weight;
• jaundice of newborns (longer than in healthy babies);
• enlarged liver and spleen;
• the skin all over the body becomes covered with a brown rash, similar to pigmentation;
• low platelet count in the blood, which poses a risk of bleeding;
• the brain is small in size, in the future there may be a lag in mental development and manifestation of mental retardation.

Recent evidence from Down syndrome researchers suggests that CMV may influence gene mutations during pregnancy. “Children of the sun” are born to couples diagnosed with TORCH infections many times more often than in other cases.

Of these 10-15% of children with severe symptoms, 2-4% may die in early infancy from internal bleeding, infant death syndrome, serious liver pathologies, bacterial infections. In the remaining 85-90% of cases, only 5-10% may experience long-term consequences, expressed in deterioration of hearing or vision, and mental retardation.

Treatment and prevention

Treatment of cytomegalovirus infection in pregnant women is carried out comprehensively. There are many medications that can be prescribed to a woman during pregnancy that prevent or at least minimize the risks of developing pathologies. But they should only be prescribed by the attending physician.

• Human anticytomegalovirus immunoglobulin. This medicine is obtained from the blood of people who have already “been ill” with the virus and have developed immunity to CMV. This method makes it possible to reduce the risk of infection of the fetus through the placenta in the event of primary infection of the expectant mother or in the event of reactivation of the virus with a high viral load.
• Antiviral drugs make it possible to stop the virus from multiplying in the mother’s blood, thereby reducing the viral load on the fetus.
• Immunomodulators are quite often prescribed by our doctors. However, in international treatment protocols no mention of this group of drugs was found in the treatment of cytohalovirus. It is impossible to claim their exceptional effectiveness or significant harm to the expectant mother’s body, since there are no relevant clinical studies.
• General strengthening agents and vitamin complexes will help improve immunity. Such treatment is possible as maintenance therapy only if the virus is inactive in a pregnant woman. In this way, you can keep it in a sleeping state and guarantee the birth of a healthy baby.

Nutrition plays an important role during every pregnancy. And if you have cytomegalovirus, you need to pay special attention to fresh vegetables and fruits that are in season. They are better absorbed by the body and bring more benefits than overseas wonders.

In addition, the diet must contain proteins of plant and animal origin. If you care about the health of your unborn baby, forget about vegetarianism, diets to keep fit, which are replete with the vastness of the World Wide Web (imagine that there are options for pregnant women too!)

Prevention

Treating cytomegalovirus is much more difficult than keeping it dormant or preventing primary infection. To do this, a pregnant woman needs to know a few simple rules Behaviors that will help you stay healthy, active, give birth to a healthy baby and enjoy the happiness of motherhood.

• Hygiene. After every walk, visiting a store, communicating with people on the street, you must thoroughly wash your hands with soap. Do not use other people's linen, personal hygiene items, towels, or shaving accessories.
• Purity. All products must be washed thoroughly. It is better to first rinse vegetables, fruits, and berries with hot water and then rinse them under running cold water. Some doctors advise washing even the containers in which products are packaged (milk, cottage cheese and others).
• Dishes. It is better to have your own individual dishes and use only them.
• Personal safety. If possible, you should avoid communicating with people who have signs of a cold or herpes on the lips.
• Vigilance. If cold symptoms appear in a pregnant woman, herpes or other unclear signs are detected, immediately seek advice.

Gynecologists recommend drinking herbal teas instead of the usual coffee, black and green tea. But you should remember that the herbs should be recommended by a doctor, since not everything can be used during pregnancy. Some can cause miscarriage, especially in the early stages.

Cytomegalovirus during pregnancy is an unpredictable thing. It may not show itself in any way, and the child will be born strong and healthy. And it can cause serious consequences that will leave an imprint on the rest of the life of both the baby and his parents.

“Forewarned is forearmed,” the ancients said. Every person who is responsible for their own condition and the health of their offspring should be aware of the consequences and take timely measures.

Should we sound the alarm if antibodies to cytomegalovirus are detected in the expectant mother’s blood? After reading the article, you can learn about the characteristics of the infection and possible risks for the expectant mother and child.

All infections caused by viruses from the HERPESVIRIDAE family (herpesviruses) have a similar pathogenesis: the disease persists, occurs in a latent or chronic form. So is cytomegalovirus: it can “sleep” in the body long years, without making itself felt at all or waking up (reactivating) from time to time.

Causes and symptoms of cytomegalovirus

Cytomegalovirus hominis (Human Cytomegalovirus) is a DNA-containing pathogenic microorganism that belongs to the family HERPESVIRIDAE (Herpesviruses). The name of the virus, “giant cell,” comes from the fact that the cells it affects can be multinucleated and enormous in size.

Cytomegalovirus is also different in that it can long time persist in the environment. This partly explains its high infectiousness.

IMPORTANT: According to WHO (World Health Organization), 2 out of 10 adolescents and 4 out of 10 adults are carriers of one or another strain of Cytomegalovirus hominis.

The source of CMV infection is an infected person. Cytomegalovirus hominis is found in his saliva, tears, nasopharyngeal secretions, semen, female genital secretions, urine and feces.

Routes of transmission of CMV and forms of CMV infection.

Cytomegalovirus hominis is transmitted, regardless of the strain:

• contact (including through objects)
• airborne
• through the placenta from mother to child
• for organ transplants or blood transfusions

Infection with cytomegalovirus infection occurs very often, its gateway is the mucous membrane lining the genitals, upper respiratory tract and gastrointestinal tract. However, the body of a healthy person can cope with it, so the disease in the vast majority of people occurs in a latent form.

IMPORTANT: The incubation period of CMV infection is 30-60 days. If a person’s immunity is strong, it suppresses the disease in 1-2 months. Suppresses, but does not cure: not active form Cytomegalovirus hominis can live in the host’s body for years and reactivate under favorable circumstances, that is, in the event of a decrease in immunity. It is difficult and not always possible to distinguish primary infection from reactivation of the virus.

Symptoms of infection appear in those who are in a state of immunodeficiency. Acquired cytomegalovirus disease is often called mononucleosis-like syndrome and manifests itself as follows:

• weakness
• low-grade fever or fever
• myalgia (muscle pain)
• swollen lymph nodes

Since Cytomegalovirus hominis can infect the respiratory system and liver, in some patients acute CMV infection can manifest itself as influenza or viral hepatitis.

If a person’s immune system is strong, after 30-60 days anti-CMV immunoglobulin is produced, and the symptoms of the disease subside.

IMPORTANT: A carrier of Cytomegalovirus hominis remains infectious for weeks and months after symptoms of CMV infection disappear.

In people with weak immune systems, as well as in pregnant women and young children, cytomegalovirus can cause:

• retinitis (inflammation of the retina of the eyes)
• pneumonia
• hepatitis
• enterocolitis
• ulcers of the esophagus, stomach, intestines
• inflammation of the genital organs
• encephalitis

Symptoms of cytomegalovirus during pregnancy. What is cytomegalovirus reactivation during pregnancy?

The development of CMV in pregnant women is possible in two cases:

• during primary infection (the risk of transplacental infection is higher)
• in case of reactivation of a virus dormant in the body (the risk of transplacental infection is lower)

If the expectant mother is a carrier of the virus, but does not have symptoms of the disease, infection of the child through the placenta may not occur.

Weakness, fever and enlarged lymph nodes are signs of CMV infection in acute form.

The clinical forms of infection caused by Cytomegalovirus hominis in expectant mothers are also different.

If the disease is acute, the lungs, liver, eyes, genitals, and brain may be affected. A pregnant woman may have complaints about:

• weakness and fatigue
• specific discharge from the nose or genital tract
• enlarged and painful lymph nodes

CMV infection affects the normal course of pregnancy. If the disease is acute, the expectant mother is often diagnosed with:

• vaginitis
• colpitis
• hypertonicity of the uterus
• premature aging of the placenta
• oligohydramnios

CMV infection can also come back to haunt a pregnant woman:

• premature placental abruption
• weakening of labor
• blood loss during childbirth
• postpartum endometritis

VIDEO: Cytomegalovirus infection and pregnancy

Cytomegalovirus during pregnancy: consequences for the fetus

Cytomegalovirus hominis can also affect a baby in the womb.

If intrauterine infection with CMV infection occurs in the early stages, pregnancy may fail.

IMPORTANT: Doctors consider the most dangerous situation to be when intrapartum infection of a child with cytomegalovirus occurs in the first trimester of pregnancy. There is a risk of fetal death or the occurrence of various serious developmental defects.

Perinatal pathologies caused by CMV infection are:

1. Regardless of the stage of pregnancy at which the infection occurred: stillbirth, prematurity, fetal malnutrition
2. Infection occurred in the early stages: malformations of the nervous system (microcephaly, hydrocephalus), respiratory organs (pulmonary hypoplasia), digestive organs, urination, heart defects
3. The infection occurred in the later stages: the birth of a child with pneumonia, jaundice of various origins, hemolytic anemia, nephritis, meningoecephalitis, etc.

Unfortunately, congenital CMV infection can result in developmental defects and health problems for the child in the future.

A child with congenital CMV infection may look absolutely healthy at first. But over time, the following may appear:

• hearing impairment up to deafness
• visual impairment up to blindness
• decreased intelligence
• speech problems

Cytomegalovirus during pregnancy planning. Analysis for cytomegalovirus during pregnancy

A woman who is serious about planning a pregnancy consults with a gynecologist, and already at this stage undergoes a test for TORCH infections, which allows her to identify a number of serious diseases that can disrupt the course of pregnancy and affect the health of the child, or antibodies to them .

IMPORTANT: The “C” in the abbreviation TORCH stands for Cytomegalovirus hominis.

The cytomegalovirus test is part of the TORCH complex.

A serological blood test allows a woman to detect the presence of anti-CMV immunoglobulins class M and G and its titer.

Antibodies to cytomegalovirus - what does it mean? Deciphering the analysis for cytomegalovirus in pregnant women

The results of an analysis for Cytomegalovirus hominis in a pregnant woman will allow the doctor to get answers to three important questions:

• Is the expectant mother infected with cytomegalovirus?
• if yes, when did the infection occur?
• if yes, is the virus active?

Analysis transcript

Indicators of cytomegalovirus during pregnancy, normal. What do cytomegalovirus titers mean during pregnancy?

A test that does not reveal IgM and IgG antibodies to Cytomegalovirus hominis is considered normal. This means that the woman is not infected. But there is absolutely no guarantee that infection will not occur in the period of time preceding childbirth.

1. A high titer of IgM in the absence of IgG indicates an acute period of CMV infection and, accordingly, a high risk of infection of the fetus
2. A high IgG titer in the absence of IgM indicates virus carriage and the possibility of reactivation
3. Low titer of IgM and IgG – infection at the attenuation stage
4. High titer of IgM and IgG – reactivation of Cytomegalovirus hominis

Changes in the titer of antibodies to CMV.

Treatment of cytomegalovirus. How to treat cytomegalovirus during pregnancy?

Unfortunately, it is impossible to completely eliminate Cytomegalovirus hominis once it has entered the body. But medicine knows ways to mobilize a person’s own immunity to fight it.
Pregnant women are usually prescribed antiviral and restorative medications. These are drugs based on interferon or herbal preparations. For example, the drug Proteflazid is considered effective.

CMV cannot be cured, but it can be controlled.

If there are no antibodies to cytomegalovirus in the blood of the expectant mother, she should take preventive measures:

• do not change sexual partner
• use condoms
• observe personal hygiene rules
• do not eat from someone else's dishes
• clean the apartment regularly
• pay due attention to your own health

What to do if cytomegalovirus is detected during pregnancy: tips and reviews

If a pregnant woman is diagnosed with Cytomegalovirus hominis, she should not consider it the end of the world. The key to a normal pregnancy is constant interaction with your doctor and strict adherence to his instructions.
In the case of an acute form of infection, the expectant mother should be tested to monitor the antibody titer every two weeks, and also be regularly examined to monitor the development of the fetus.

VIDEO: Cytomegalovirus during pregnancy

Pregnancy is a condition in which the immune system of a representative of the fair sex is weakened and subject to difficult tests. Because of this, a pregnant woman may face various diseases and experience them for yourself. It is known that illnesses during pregnancy can have a negative impact on the child. Of particular danger is cytomegalovirus during pregnancy. It can cause abnormalities in the development of the fetus or even its death in the womb.

There are probably no people in the world who have not experienced a disease such as herpes. People call it a “cold.” Herpes, appearing on the lips and face, spoils appearance and causes a lot of discomfort (itching, burning). It is known that this virus, once it enters the human body, 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. Many people on the planet can be diagnosed as positive for cytomegalovirus.

However, some do not even realize that there is an infection in the body - it does not manifest itself at all, like other viruses that are part 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 cytomegalovirus is introduced into the human body? The name of the disease “cytomegaly” translated means “giant cell”. Due to the action of cytomegalovirus, normal cells of the human body increase in size. Microorganisms entering them destroy the cellular structure. The cells fill with fluid and swell.

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

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

This viral infection can enter the child’s body: 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, sperm, vaginal secretions, urine, saliva.

Symptoms of cytomegalovirus

If a person has a strong immune system, the virus does not manifest itself. It is found in the body as 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 normal immune systems is mononucleosis-like syndrome, which appears high temperature, malaise, headache. It occurs approximately 20-60 days after infection. The duration of mononucleosis-like syndrome can be 2-6 weeks.

The most common symptoms that occur during pregnancy and cytomegalovirus are: reminds me of ARVI. This is why many pregnant women mistake cytomegalovirus for a common cold, because almost all of its symptoms are observed: increased body temperature, fatigue, weakness, runny nose, headaches, enlarged and inflamed salivary glands, and sometimes even inflamed tonsils. 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. Autonomic-vascular disorders and multiple lesions of various internal organs are also possible.

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

• 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 mainly manifests itself with symptoms similar to a cold. All other signs listed above occur extremely rarely and only in cases of a very weakened immune system.

The danger of cytomegalovirus during pregnancy

Virus infection is very dangerous first trimester pregnancy. Cytomegalovirus can penetrate the placenta into the fetus. Infection can cause intrauterine death.

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

Terrible consequences can be avoided if the virus is detected in time, so it is very important to plan your pregnancy and get tested for any infections before conception, as well as regularly visit a doctor during “ 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 independently find out about the presence of cytomegalovirus in your body. The virus, being in a latent form, does not manifest itself in any way. 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 more precisely for TORCH infection. It is used to detect the presence or absence of not only cytomegalovirus, but also rubella (types 1-2).

Cytomegalovirus is diagnosed using the following methods:

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

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, and saliva are used for research.

At 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.

Purpose serological studies blood serum is the detection of antibodies that are specific for cytomegalovirus. The most accurate method is linked immunosorbent assay(ELISA), which provides determination different types immunoglobulins (IgM, IgG).

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

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

The results of the analysis for cytomegalovirus may indicate several options:

1. IgM was not detected, IgG was within the normal range;
2. IgM is not detected, IgG is higher than normal (positive IgG cytomegalovirus during pregnancy);
3. IgM is higher than normal.

In the first case, the female body did not come into contact with cytomegalovirus, which means that preventive measures and avoid situations where you can become infected.

The second analysis indicates that the female body has encountered the virus, but at the moment it is in an inactive form. There is no need to worry about primary infection during pregnancy, but there is a risk of reactivation of the virus.

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

It is worth noting that IgM is not always detected. Doctors focus on the IgG level. Normal IgG levels may vary among different women. It is advisable to get tested before conception. This allows you to determine the norm 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” the cytomegalovirus in an inactive (passive) state.

For pregnant women who have the virus, doctors prescribe vitamins and 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 prophylaxis.

You can support your immune system with herbal teas. Herbal teas 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 cause miscarriage. The doctor will tell you which tea composition is best to choose and recommend herbal infusions, which can be purchased at any pharmacy.

If the disease is active, then immunomodulating drugs, vitamins and teas alone will not be enough. Doctors prescribe antivirus agents. The goal of treating cytomegalovirus during pregnancy is to avoid complications. This therapy will allow women in pregnancy to carry a baby and give birth to him healthy without any abnormalities.

CMV can cause a number of concomitant diseases(for example, ARVI, pneumonia). Successful treatment of cytomegalovirus infection depends on treatment of any other underlying disease. The use of drugs to treat concomitant diseases in combination with antiviral and immunomodulatory drugs will allow the cytomegalovirus to be cured and rendered inactive when its activity is controlled by the immune system.

You cannot treat cytomegalovirus infection on your own. Only professional doctor may prescribe the necessary medications. He makes his decision based on the form of the infection, the patient’s immunity status, her age, and the presence of concomitant diseases. Woman wanting to give birth healthy child, must follow all 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 pregnant must follow preventive measures. They will also be useful for those people in whose bodies the virus is in a “dormant” state.

First, women who want to avoid exposure to cytomegalovirus during pregnancy should avoid casual sex. You should not have sex without a condom. Doctors constantly remind their patients of this. 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 clean your home and yourself, follow the basic rules of personal hygiene, which are instilled in all of us from an early age. For example, you should not use someone else’s dishes or washing supplies (washcloths, towels), as there is a small risk of contracting cytomegalovirus through them. Before eating, before and after visiting the toilet, after contact with other people's objects (for example, money), you need to thoroughly wash your hands.

Definitely worth it strengthen your immune system. To do this, it is recommended to do this daily physical exercise which are recommended for pregnant women, go for walks more often fresh air, perform hardening procedures. Good immunity will not allow the occurrence of acute cytomegalovirus infection, but will “keep” the pathogens in an inactive form.

Plays a huge role balanced diet . Unfortunately, many people do not monitor their diet, eat their favorite dishes, refusing healthy products(eg vegetables). The menu should be designed in such a way that it contains food containing vitamins and useful material in the required quantity. Due to their deficiency, the immune system can weaken, and this is fraught with various diseases. There is no need to sit on a limiting one, since 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. When planning pregnancy, cytomegalovirus can be detected through testing. Not only the woman, but also her man should undergo examinations.

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 dire consequences (especially in the early stages). If you experience cold symptoms during pregnancy, you should immediately consult a doctor, because it could be a cytomegalovirus infection. There is no need to self-medicate, since medications chosen independently may not help, but only harm.

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