Cytomegalovirus infection (CMV) in pregnancy: which safe treatment to choose? IgG cytomegalovirus test positive during pregnancy

08.08.2019

Pregnancy is a condition in which the immune system of the fair sex is weakened and subject to difficult tests. Because of this, a woman in a position can face various diseases and experience them on herself. It is known that illnesses while carrying a child can negatively affect him. A particular danger is cytomegalovirus during pregnancy... It can cause abnormalities in the development of the fetus or even its death in the womb.

Probably, there are no people in the world who have not experienced such a disease as herpes. People call it "a cold". Herpes, appearing on the lips and face, spoils the appearance and delivers a lot of uncomfortable sensations (itching, burning). It is known that a given 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 (cytomegalovirus) is very common. On the planet, many people can be diagnosed with positive cytomegalovirus.

However, some do not even know about the presence of 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 the introduction of cytomegalovirus into the human body? The name of the disease "cytomegaly" means "giant cell". Due to the action of cytomegalovirus, normal cells of the human body increase. Microorganisms, getting into them, destroy the cellular structure. The cells fill with fluid and swell.

There are several ways to become infected with cytomegalovirus during pregnancy:

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

This viral infection can enter the baby's body: while it is in the womb, during childbirth or during breastfeeding.

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

Symptoms of cytomegalovirus

If a person has strong immunity, then the virus does not manifest itself. It is 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 a normal immune system is mononucleosis-like syndrome, which is manifested by high fever, malaise, headache. It occurs approximately 20-60 days after infection. The duration of mononucleosis-like syndrome can be 2-6 weeks.

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

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

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

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

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

Danger of cytomegalovirus during pregnancy

Infection with a virus in first trimester pregnancy. Cytomegalovirus can cross the placenta into the fetus. Infection can cause fetal death.

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

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

Analysis for cytomegalovirus during pregnancy

It is almost impossible to independently find out about the presence of cytomegalovirus in your body. The virus, being in a latent form, absolutely 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 rather, for TORCH infection. With the help of it, the presence or absence of not only cytomegalovirus, but also rubella (types 1-2) is detected.

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 based on the definition of deoxyribonucleic acid, which is the carrier of the hereditary information of the virus and is contained within it. For research, scrapings, blood, urine, sputum, saliva are used.

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.

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

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

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

Several options can be indicated in the results of the analysis for cytomegalovirus:

IgM not detected, IgG within the normal range;
IgM is not detected, IgG is higher than normal (positive IgG of cytomegalovirus during pregnancy);
IgM is above normal.

In the first case, the female body has not been in contact with cytomegalovirus, which means that preventive measures should be taken and situations in which you can get infected should be avoided.

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

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

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

Treatment of cytomegalovirus during pregnancy

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

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

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

If the disease is active, then some immunomodulatory drugs, vitamins and teas will not be enough. Doctors appoint antivirus tools... The goal of treating cytomegalovirus during pregnancy is to avoid complications. Such therapy will allow women in a position to carry a baby and give birth to him healthy without any deviations.

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

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

Prevention of cytomegalovirus

Not all people are carriers of cytomegalovirus. A woman who is not infected with it and is planning a child or is already in a position must observe preventive measures. They will also be useful for those people in whose body 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 enter into intimate relationships 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, to follow the elementary rules of personal hygiene, which are instilled in all of us from an early age. For example, you cannot use other people's dishes, washing utensils (washcloths, towels), since there is a small risk of contracting cytomegalovirus through them. Before eating, before and after using the toilet, after touching other people's objects (for example, money), you should thoroughly wash your hands.

Definitely worth it strengthen your immune system... To do this, it is recommended to do daily physical exercises that are recommended for pregnant women, walk more often in the fresh air, and perform hardening procedures. Good immunity will prevent the emergence 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 foods, refusing healthy foods (for example, vegetables). The menu should be designed in such a way that it contains food containing vitamins and nutrients in the required amount. Due to their lack, the immune system can weaken, and this is fraught with various diseases. There is no need to sit on the limiting one, since this will not lead to anything good either.

In order not to face cytomegalovirus infection and its complications during pregnancy, conception must be planned in advance. When planning pregnancy, cytomegalovirus can be detected through testing. The examination should be carried out not only by the woman, but also by her man.

In conclusion, it should be noted that cytomegalovirus infection is very dangerous for a pregnant woman. Disguising itself as a common cold, it can lead to dire consequences (especially in the initial period). If you experience colds during pregnancy, you should immediately consult a doctor, because it may be a cytomegalovirus infection. You do not need to self-medicate, since the drugs you choose yourself may not help, but only harm.

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During pregnancy, women should pay special attention to their health, because there are many infections of bacterial and viral etiology that can affect the development of the fetus. In case of infection, it will be very difficult to get rid of the disease. A latent cytomegalovirus infection is not dangerous for the expectant mother and baby, but when reactivated, it can harm the health of both.

What is cytomegalovirus?

Currently, cytomegalovirus infection is found in more than 50% of people over the age of 35. The study of this disease began about 60 years ago, so therapeutic methods are still the subject of scientific discussions.

From the point of view of microbiology, the causative agent of the disease cytomegalovirus is an extracellular infectious agent that belongs to the herpesvirus family and has a similar structure. Viral particles have an oval shape with a diameter of 150-250 nm. They are covered with a lipoprotein membrane with small processes in the form of spines.

Once in the human body, cytomegalovirus penetrates under the cell membrane and begins to destroy cells from the inside. Most of the viral particles are deposited in biological fluids such as saliva, tears, urine, blood, semen, and vaginal secretions.

After infection, the nuclei of infected cells contain cytomegalovirus DNA, therefore, simultaneously with protein synthesis, the formation of CMV particles occurs. Thus, the area of infection is gradually increasing.

In most cases, the disease does not have pronounced symptoms. Signs of infection appear when the immune system is severely weakened. During pregnancy, there is a risk of infection of the baby, which can lead to the development of pathologies in him.

Ways of infection and causes of the disease in pregnant women

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Cytomegalovirus is found in various biological fluids, so there are several ways of infection:

CMVI infection by the contact-household route is rare, since the activity of extracellular agents outside the human body persists for a short time. You can become infected in everyday life after contact with personal hygiene items or dishes of an infected person.
The most common route of CMV transmission is through sexual contact with an infected partner. It is possible to become infected with a cytomegalovirus infection at the time of conception, which will subsequently lead to serious deviations in the baby during intrauterine development and to the occurrence of dangerous diseases after the baby is born.

Infection by airborne droplets occurs when saliva or muconasal secretions of a virus carrier enter the skin or mucous membranes of a healthy person when coughing, sneezing and kissing.
A parenteral route of infection is also possible, in which the causative agent of the disease enters the bloodstream. In this way, you can get infected through blood transfusion, surgery, using dirty syringes.
The placental mode of infection involves the transmission of the virus to the fetus from the mother through the placenta. How much this will affect the baby will depend on the combination of accompanying factors.
If a woman is a carrier of the infection, she can infect a newborn while breastfeeding. To eliminate the likelihood of infection, the infant should be transferred to artificial mixtures.

Cytomegalovirus is transmitted to the fetus through the placenta

Cytomegalovirus is most dangerous to the fetus when the primary infection of the mother occurs during pregnancy. If a woman was a carrier of the virus before conception, antibodies to the causative agent of the disease are present in her body, which means that the likelihood of negative consequences for the baby's health is minimal. In 90% of cases, such women in labor give birth to healthy children.

Varieties and symptoms of cytomegalovirus infection

The duration of the course of this viral disease is very difficult to determine, since most often the infection is latent, and it does not have pronounced symptoms. The incubation period is conventionally a time interval lasting 1-2 months before the appearance of characteristic signs of the disease.

Experts distinguish several types of cytomegalovirus infection:

Congenital form of the disease, the main symptoms of which are enlarged liver and spleen. Against the background of a congenital infection, jaundice may develop, there is a risk of internal hemorrhage. Subsequently, the disease can lead to pathologies of the central nervous system.
The acute form of infection is characterized by the appearance of a white coating on the surface of the tongue and gums, as well as characteristic symptoms of the common cold. The main route of infection is sexual, but infection can also occur during blood transfusion.
With the generalized form of CMVI, inflammatory processes develop in the internal organs (adrenal glands, kidneys, spleen, pancreas). This is usually due to a weakening of the body's immune system. In most cases, inflammation is accompanied by bacterial infections.

The severity of symptoms characteristic of cytomegalovirus infection depends on the body's defenses. With strong immunity, the disease is accompanied by general weakness, headache and fever. Signs of infection appear 3-8 weeks after infection. With appropriate treatment, recovery occurs within 15-40 days.

Signs of infection during pregnancy are similar to those of a common cold, and therefore do not cause any particular concern in expectant mothers. The main difference between this infection and ARVI is the duration of the persistence of unpleasant symptoms. Runny nose, headaches, sore throat and high body temperature do not go away within 1 to 2 months.

With reduced immunity, the disease can lead to serious consequences. Pregnant women who have had CMVI can develop pneumonia, encephalitis, arthritis, nervous disorders and other pathologies of vital organs.

The disease in generalized form is very rare. In this form, it affects most of the internal organs. Viruses provoke the development of inflammatory processes in the lungs, kidneys, liver, spleen, pancreas, gastrointestinal tract, organs of vision. In severe cases, the infection can cause paralysis and tumor formation in the brain.

Diagnostic tests

Diagnosis of the disease in women should be carried out at the stage of pregnancy planning. To detect cytomegalovirus, it is required to collect saliva, blood, urine and vaginal scrapings for further laboratory tests. In pregnant women, the infection is detected by a blood test.

Due to the fact that the disease does not have a clear clinical picture, it becomes necessary to conduct an analysis to identify specific antibodies indicating the presence of viral particles in the body.

There are several diagnostic methods that are used when cytomegalovirus infection is suspected:

Serological - the use of IgG and IgM immunoglobulins to detect antibodies to this virus in the body. If the test shows a positive IgM, this indicates that the CMV infection was recent, and there is a risk of infection of the fetus. The presence of IgG antibodies in the blood indicates a chronic form of the disease.
Molecular biological - allows you to detect the DNA of the virus in the cells of biological material used for analysis.
Cytological - used to detect enlarged cells containing viral particles in the secretory fluids of pregnant women.
Virological - is considered the most difficult microbiological method, since to obtain a result, it is necessary to cultivate biological material on a nutrient medium.

If the diagnostic tests show a negative result, the expectant mother needs to donate blood every trimester for appropriate tests in order to exclude a potential threat to the baby's health. A child born from an infected mother is diagnosed in the first days after childbirth.

If an infant has a positive IgG reading, this is not evidence of congenital CMV infection. An acute form of infection can be talked about when IgM antibodies are detected in a child.

Features of treatment during pregnancy

Therapeutic measures for detecting cytomegalovirus infection in pregnant women are to take immunomodulators, as well as drugs containing immunoglobulins. Antiviral drugs are contraindicated for expectant mothers at any stage of pregnancy, because contain toxic substances that can provoke the appearance of dangerous pathologies and developmental abnormalities in the fetus.

An infected woman should be under constant medical supervision to prevent unwanted consequences. If the mother's immune system is normal and the disease does not become active, cytomegalovirus most likely will not affect the baby's health.

The treatment regimen for CMVI and the choice of drugs depend on the severity of the disease and the duration of pregnancy. The most effective in such situations are drugs that prevent the multiplication of viruses at the intracellular level.

When the drug acts on viral particles, the destruction of the cell wall does not occur. Such drugs are safe for the health of women and children, since they do not contribute to the accumulation of toxic toxins in the blood. Pharmaceutical agents that block DNA synthesis in viral cells include Viferon, Giaferon, Altevir, Kipferon, Cymeven.

Acyclovir and other highly toxic antiviral drugs are used to treat the generalized form of the disease in pregnant women exclusively in a hospital setting. If the severe course of the disease has led to the development of serious pathologies in the fetus, doctors may advise the woman to terminate the pregnancy.

Possible consequences of cytomegalovirus infection

If the primary infection of the mother with cytomegalovirus occurred during pregnancy, the baby may be born with serious pathologies. The likelihood of developing abnormalities is very high, but this does not mean that the child will necessarily have health problems. There are cases when infection of a pregnant woman with cytomegalovirus did not affect the growth and development of the fetus.

Infected babies are often born with low birth weight, which returns to normal within a few months. Many babies are passive carriers of cytomegalovirus, which does not affect their well-being in any way. Due to the absence of any symptoms of the disease, parents do not have any suspicions that an infectious agent is present in the baby's body.

For mother

With the onset of pregnancy in women, immunity decreases, because the natural mechanism of its suppression turns on. This makes the female body more vulnerable to various infections. Infection with cytomegalovirus can lead to the development of inflammatory processes in the genitals and intestines in the mother, as well as the appearance of diseases such as pneumonia, hepatitis, cholecystitis, enterocolitis, rheumatoid arthritis, pleurisy, multiple sclerosis, and brain cancer.

For the fetus

Primary infection early in pregnancy leads to severe consequences for the baby. In the first months of the fetus, all vital organs and systems are formed. Penetrating into the chromosomes of the embryo, cytomegalovirus causes their damage, which affects the tissues of the ovum and the whole organism. This leads to a halt in fetal development or spontaneous abortion.

If infected at the end of the 1st trimester, the fetus may remain viable, but there is a high probability of serious abnormalities in the baby. A similar result is observed if the infection enters the body in the 2nd trimester of pregnancy.

How cytomegalovirus will affect the baby's health, if the infection happened in late pregnancy, depends on whether the infection was primary, or the chronic form of the disease was reactivated. With the transition of a latent infection into an active phase immediately before childbirth, no serious pathologies are observed in children. The initial infection of a woman during this period leads to the birth of an infected baby or to stillbirth.

If viral particles are present in the mother's vagina, the baby can become infected during childbirth. A congenital disease manifests itself in an infant with the following symptoms:

an increase in the size of some organs (liver, spleen), prolonged jaundice, internal bleeding;
the appearance of pathologies accompanied by impaired consciousness, decreased sucking reflex, accumulation of fluid in the brain, damage to the organs of vision;
in the generalized form, damage to the tissues of most internal organs occurs, which leads to hepatitis, encephalitis, pneumonia and other pathologies.

Generalized infection in newborns is often fatal in the first months of life. Reactivation of the latent form of the disease or infection at the beginning of the 2nd trimester leads to the appearance of:

fibrosis of the lungs;
heart defects;
liver cysts;
impaired renal function;
malformations of the digestive system;
congenital deformity.

Cytomegalovirus at the planning stage of pregnancy

During pregnancy planning, it is necessary to undergo an examination for CMV. During the analysis, the woman reveals the presence of antibodies to TORCH infections (cytomegalovirus, toxoplasmosis, rubella, herpes), which can have a negative effect on the development of the embryo.

An analysis for CMV is not mandatory, but most of the attending physicians recommend taking it in order to determine the possible risks of abnormalities in the fetus.

The most effective method for detecting cytomegalovirus in expectant mothers is an enzyme-linked immunosorbent assay, which determines the presence or absence of class G and M immunoglobulins in the female body.

Cytomegalovirus infection- This is a fairly common pathology, which in the vast majority of people is asymptomatic and does not cause any serious health problems. However, cytomegalovirus during pregnancy is of particular relevance, since infection of expectant mothers with this infection can lead to the development of complications in the course of pregnancy itself, as well as provoke the formation of various pathologies of the fetus and newborn.

Cytomegalovirus and pregnancy

Cytomegalovirus, or CMV (Cytomegalovirus; CMV) belongs to the fifth type of representatives of the herpesvirus family, which are pathogenic for humans. A common feature of such viruses is their long (and more often - lifelong) stay in the human body - persistence with the development of a chronic course of the disease.

For pregnant women, the danger of cytomegalovirus lies primarily in the risk of damage to the fetus and newborn.

Some facts about CMV in pregnancy:

According to various sources, 60–95% of the world's adult population are infected with cytomegalovirus infection, which has a latent course.
That is why most pregnant women have specific antibodies against cytomegalovirus in their blood.
Cytomegalovirus infection can be congenital or acquired.
During pregnancy, cytomegalovirus infection can be primary (acute) or chronic activation occurs.
According to statistics, primary cytomegalovirus infection occurs in about 1–2% of all pregnant women.
If pregnancy occurs, and cytomegalovirus enters the woman's body for the first time, in almost half of the cases, infection of the fetus also occurs. This is due to the lack of protective antibodies in the body of a pregnant woman.
Obvious manifestations of congenital cytomegalovirus infection are diagnosed in 7–20% of these newborns. In other children, the disease is asymptomatic or has late manifestations.
When a latent infection is reactivated, the virus is transmitted to the fetus in only about 1% of all cases.

Ways of transmission of cytomegalovirus during pregnancy

This virus is found in almost all biological fluids of the body: blood, saliva, urine, semen, discharge from the cervical canal and vagina, breast milk, amniotic fluid, nasopharyngeal mucus, feces, etc.

The highest concentration of cytomegalovirus is detected in the salivary glands.

The source of infection is an infected person with an explicit or latent (latent) course of infection.

During pregnancy, cytomegalovirus can be infected in various ways, but the most common of them are airborne and sexual.

The likelihood of transmission of infection during kissing is high, given its "favorite" localization in the salivary glands.

Transmission of CMV to a child:

During pregnancy, cytomegalovirus can be transmitted to the fetus and newborn in two ways: transplacentally (intrauterinely) and during childbirth - intrapartum.
Intrauterine infection of the fetus is possible at any stage of pregnancy.
The most severe consequences for the fetus occur when it becomes infected in the first half of pregnancy.
At the same time, cytomegalovirus affects the course of pregnancy in direct proportion to the period at which infection occurred. For example, a miscarriage may occur in the first half of pregnancy.
During childbirth, the unborn child can become infected with this virus by coming into contact with infected secretions of the cervix and vagina.
According to statistics, intrapartum infection with cytomegalovirus occurs several times more often than intrauterine infection.
A newborn can become infected with cytomegalovirus infection if the mother does not comply with hygiene standards or through infected breast milk.

CMV symptoms

In a significant number of cases in healthy people with a normal state of immunity, cytomegalovirus infection is completely asymptomatic. However, pregnancy is a temporary physiological factor in the weakening of the body's defenses. Therefore, during this period, cytomegalovirus infection occurs somewhat more often with the appearance of clinical symptoms.

The range of clinical manifestations of the disease varies from almost asymptomatic lesions of the salivary glands (sialoadenitis) to severe pathology of the liver, respiratory system and brain.

Most often, during pregnancy, symptoms of cytomegalovirus infection can resemble the course of another disease - mononucleosis. This is manifested by weakness, fever, muscle pain, and enlarged lymph nodes.

Sometimes infection with cytomegalovirus occurs against the background of an acute respiratory illness. In this case, the symptoms of cytomegalovirus infection are completely covered by the manifestations of concomitant respiratory pathology.

In the case of frequent exacerbation of latent chronic cytomegalovirus infection, the disease may also be asymptomatic. However, such women often have data on missed pregnancies or miscarriages in the past, stillbirths or the birth of children with developmental defects.

The main consequences of cytomegalovirus during pregnancy are various signs of damage to the fetus and newborn.

Signs of CMV infection in the fetus and newborn:

With a primary infection in the first trimester of pregnancy, the fetus may die. It is also possible for him to develop severe malformations, often incompatible with life.
Infection of the fetus in the last trimester and during childbirth often leads to the formation of congenital cytomegalovirus infection.
Its main manifestations are: damage to the liver and spleen, eyes, hearing organ, brain structures, a decrease in the number of platelets in the blood, etc.
Often, such children are born small, have signs of intrauterine growth retardation.
But still, congenital CMV infection is more often asymptomatic.
According to some scientists, intrauterine CMV infection is fraught with damage to the central nervous system. Moreover, the first signs of such a lesion (mental retardation, psychomotor disorders, etc.) may appear in a child even several years after birth.
Due to the impaired immune response, these newborns often develop bacterial complications.

Detection of cytomegalovirus in pregnant women

Currently, two methods for diagnosing cytomegalovirus infection in pregnant women are widely used: enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR).

An enzyme-linked immunosorbent assay is used to determine the state of specific immunity as a result of the determination of antibodies to cytomegalovirus. Usually, IgM, IgG and, in some cases, IgG avidity are detected.

Principles of CMV diagnostics using ELISA:

In most countries, mandatory screening for cytomegalovirus infection is carried out for all pregnant women registered.
The appearance of IgM in the blood indicates primary infection (acute phase of infection) or reactivation of a chronic infectious process.
IgG determination may indicate a past infection.
If a positive IgM cytomegalovirus is detected in the absence of IgG, then this is an acute infection.
If both IgM and IgG are detected, primary infection should be differentiated from reactivation of chronic infection.
For this purpose, the avidity of IgG is determined. A low avidity indicates a recent infection, while a high avidity indicates a long-term infection.
If it is impossible to carry out an analysis for avidity, an analysis of the so-called paired sera is performed: a repeated study of antibodies of both classes after two to three weeks.

The rate of cytomegalovirus in enzyme immunoassay in pregnant women: IgM is not detected, IgG - in a low titer. Unfortunately, it is not possible to indicate an exact figure for the IgG level norm, since these indicators are different for different laboratories. Typically, reference values (norm) are indicated in the response form of a particular laboratory to enable the doctor to correctly interpret the test results.

The polymerase chain reaction is used for the qualitative determination of the pathogen in the biological media of the body in case of controversial ELISA results, as well as for prenatal diagnosis of infection (for example, the study of amniotic fluid).

Principles of treatment and prevention

Antiviral treatment for CMV during pregnancy is contraindicated in most cases. The only indication for the appointment of such therapy is a life-threatening condition of a pregnant woman, which is provoked by cytomegalovirus and its consequences (for example, a generalized form of infection with damage to vital organs).

In order to reduce the negative effect of the virus on the fetus in case of primary infection during pregnancy, it is possible to administer a specific CMV immunoglobulin, as well as the appointment of certain types of immunomodulators.

In case of detection of fetal developmental abnormalities incompatible with life, the woman may be asked to terminate the pregnancy.

The method of delivery, according to most experts, is not of fundamental importance.

Basics of CMV Prevention:

It is important for a woman to ask the question: what kind of disease is it and how to prevent its negative consequences, even at the stage of pregnancy planning.
When carrying out pregravid preparation, it is necessary to examine the level of antibodies to cytomegalovirus in the blood.
Based on the results of such a study, the attending physician will be able to give the necessary recommendations.
Prevention of CMV infection during pregnancy is to limit visits to large crowds, maintain a healthy lifestyle, and personal and sexual hygiene.

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Cytomegalovirus is one of the most widespread pathogenic microorganisms on Earth. At the same time, most people do not know about their infection, since their disease exists for a long time in a latent form and does not give obvious clinical manifestations.

But for women of childbearing age, the carriage of CMV (cytomegalovirus) is a rather serious problem and requires special attention. This is due to the possibility of intrauterine infection of the developing child. Therefore, the analysis for CMV is included in the list of examinations recommended for planning and the onset of pregnancy.

What is important to know about cytomegalovirus

The causative agent of cytomegalovirus infection is a large DNA-containing virus of the herpesvirus family. It has a spherical shape and is covered with a two-layer protective outer shell. On its surface there are numerous spine-like outgrowths formed by lipoprotein molecules. They are necessary for the recognition of cells of the macroorganism, attachment and penetration into them.

The features of the life cycle of cytomegalovirus include:

Cytomegalovirus has no gender or age preferences; it can infect people of any race. It is fairly stable in the environment, which explains its ubiquitous distribution.

Epidemiology

Cytomegalovirus infection is mainly transmitted by contact-household, airborne droplets and sexually, and the source of infection can be a person without obvious clinical manifestations of the disease. This explains the high degree of infection of the population. According to the WHO, almost 90% of urban residents in developed countries and 60-70% of those living in rural areas are infected with this virus. More than half of healthy children born to school age become carriers of CMV infection.

The vertical transmission route is also of great importance, contributing to intrauterine infection of the fetus. The fact is that cytomegalovirus is able to overcome the hematoplacental barrier at any gestational age, which contributes to the development of congenital cytomegalovirus infection. A baby can become infected from an infected mother also during the passage of the birth canal and during breastfeeding. In addition, there is a possibility that the fetus will receive the virus from the father if his sperm contain embedded DNA of this pathogen.

Transmission of cytomegalovirus is possible through organ transplantation and transfusion of blood (and blood components) from infected donors. In rare cases, infection occurs through contaminated medical instruments during various medical procedures.

The main manifestations of the acquired infection

In people infected during their life, cytomegalovirus infection can exist in several forms:

latent course, the virus does not lead to the appearance of any external symptoms, but can be detected by laboratory methods;
subclinical persistent infection, manifestations are minimal and nonspecific, viral particles are found in various biological secretions of an infected person;
the appearance of diseases associated with CMV: pneumonia (pneumonitis), hepatitis, mumps, cytomegalovirus mononucleosis, enterocolitis, encephalitis, nephritis, chronic urogenital pathology;
generalized form of cytomegalovirus infection with multiple organ damage and severe course, the development of dementia due to chronic encephalitis, with the appearance of multiple bleeding ulcers in various parts of the gastrointestinal tract.

The vast majority of people infected with cytomegalovirus have a latent course of the disease. In this case, the detection of infection occurs during a targeted examination in preparation for transplantation, donation, at the stage of pregnancy planning and treatment.

Virus activation occurs most often when the immune status changes with the development of immunodeficiency of any origin. This is possible with HIV, after severe infections, with immunosuppressive therapy after transplantations, with certain blood diseases and during chemotherapy. All this can lead to a decrease in immunological control over the existing cytomegalovirus infection and the transition of the pathogen to the active phase. Cytomegalovirus reactivation during pregnancy is also common.

The elimination (or correction) of immunodeficiencies and the treatment carried out contribute to the inhibition of viral replication, a significant purification of biological fluids from viral particles. But the pathogens located intracellularly are not destroyed, the infection goes into a latent phase. A repeated violation of the immune status causes a new exacerbation of cytomegalovirus.

Is cytomegalovirus dangerous during pregnancy?

Cytomegalovirus infection during pregnancy can be a consequence of the initial infection of a woman or the reactivation of a virus that she already has. The severity of the symptoms arising from this depends on the functional state of the immune system, which affects the rate of increase in the level of the pathogen freely circulating in the blood.

Acute CMV infection during pregnancy can manifest itself as an intoxication-febrile syndrome, signs of damage to the submandibular and parotid salivary glands, kidneys, liver and lungs. The appearance of mucous discharge from the nose is possible, which, coupled with intoxication, gives rise to false assumptions about ARVI. It is also often noted with an increase in vaginal discharge, which is white-bluish in color and rather liquid in consistency. Such symptoms of cytomegalovirus during pregnancy indicate the defeat of more and more organs, but are not dangerous to the life of a woman and her developing child.

But cytomegalovirus can also infect the internal genital organs. This poses a threat to the successful carrying of pregnancy, increases the risk of spontaneous abortion in the early stages, premature birth. And with a premature detachment of a normally located placenta arising against the background of hypertonicity, intrauterine fetal death is possible.

A great danger is the defeat of the placenta by cytomegalovirus. At the same time, cysts are formed in it, its premature aging is noted. And with infection in the early stages of gestation, intimate attachment to the body of the uterus of the chorionic tissue of the placenta is possible, which threatens uterine atony and bleeding in the postpartum period.

The consequences of cytomegalovirus infection for the fetus

The presence of CMV in a pregnant woman poses an immediate danger to the child. Intrauterine infection is fraught with the development of a congenital form of the disease with the development of severe complications. Therefore, this infection is attributed to the embryopathogenic group TORCH, women are recommended to be tested for cytomegalovirus when planning pregnancy.

Depending on the gestational age, the newborn may show signs of acute cytomegalovirus infection, the consequences of impaired embryogenesis, or symptoms of chronic damage to many internal organs. At the same time, children are often born prematurely, with signs of prematurity. At the same time, an asymptomatic (at first) course of the disease is possible with the appearance of the consequences of infection after the first six months of life.

The main clinical signs of congenital intrauterine infection in young children:

pastiness and yellowness of the skin in newborns, the appearance of characteristic spots of dark blue color and multiple petechiae is possible;
tendency to lingering jaundice;
lethargy, drowsiness, inactivity of children, even with obvious physical discomfort;
persistently and diffusely reduced muscle tone, limb tremor, lagging behind peers in motor development;
violation of sucking and swallowing, which causes persistent hypotrophy and polyhypovitaminosis;
microcephaly (when infected in the early stages of gestation);
hematological abnormalities: anemia of mixed origin and thrombocytopenia;
cytomegalovirus retinitis with a drop in visual acuity;
sensorineural hearing loss with a tendency to a gradual increase in the degree of hearing loss;
mental retardation;
interstitial pneumonia, nephritis, myocarditis, colitis, pancreatitis and damage to other parenchymal organs and the brain.

When a child is infected shortly before childbirth or in the process of passing through the birth canal, he does not show signs of organ damage. But during the first 20-50 days, a condition develops, the clinic of which resembles ARVI. It usually quickly stops due to the intake of protective antibodies in breast milk, and the infection becomes latent. But in premature and hypotrophic newborns, especially if they are predominantly artificially fed and suffer from immunodeficiency states, a more severe course of the disease with a tendency to generalization is possible.

When and who needs to be tested for CMV?

In the absence of immunodeficiency in a person, his existing cytomegalovirus infection does not pose a potential threat to life and usually does not affect its quality. Therefore, the widespread routine examination of the population for cytomegalovirus is not practiced, moreover, the presence of signs of infection (which is noted in almost 90% of people) is not a basis for active therapeutic measures.

Referral for tests is received by:

women with a history of the habit;
infertile couples, including at the stage of preparation before carrying out and other assisted reproductive technologies;
suffering from chronic inflammatory diseases of the urogenital sphere;
mothers of children born with signs of intrauterine infections;
persons with immunodeficiencies;
prospective donors.

But it is advisable to take the analysis for cytomegalovirus when planning pregnancy to all women. Determining the presence of infection and the degree of activity of the process will help to further assess the risk of infection of the fetus.

Diagnostics

Cytomegalovirus infection has no characteristic symptoms, so clinical diagnosis is difficult. And laboratory tests are key.

Currently used for diagnostics:

culture method (cultivation of a virus taken from biological fluids or tissues on special media);
PCR - allows you to determine even a small amount of virus DNA in the studied biomaterial (in a smear from the urethra, vagina, cervical canal, in blood, urine, cerebrospinal fluid or saliva);
ELISA is the most frequently used study based on the determination of different classes of specific antibodies in the blood;
the cytological method, in which pieces of tissue taken by the biopsy method are examined under a microscope, makes it possible to identify characteristic changes in cells.

ELISA is used in everyday clinical practice. This inexpensive and technically relatively uncomplicated study is carried out automatically and has no age restrictions. It can be repeated the required number of times, which makes it possible to dynamically assess the course of the infectious process and approximately determine the duration of the infection.

ELISA decoding

When conducting ELISA, the presence and titer of immunoglobulins Ig M and Ig G is determined. These are different classes of specific protective antibodies produced by immune cells. Their ratio is necessarily assessed if the test for cytomegalovirus during pregnancy is positive.

The presence of Ig M indicates an ongoing infectious process, is a sign of recent infection or activation of cytomegalovirus. The detection of such antibodies requires a decision on the need for treatment, and in pregnancy - a commission assessment of risks to the fetus. Ig G indicate the presence of strong immunity. They appear some time after infection and persist for life. It is this class of antibodies that provides the body with immunological control over the virus, restraining its reproduction and spread.

The result of up to 0.9 IU / ml is the norm of Ig G to cytomegalovirus, indicating the absence of contact with the virus. The indicator 0.9-1.1 IU / ml is considered doubtful, and above 1.1 IU / ml - positive. In children under 3 months of age, the level of Ig G is not determined. After all, they have not yet developed their own antibodies, and the complexes circulating in the blood were obtained in utero from an infected mother.

A positive Ig M in a pregnant woman with questionable Ig G results indicates an active stage of primary infection. And the combination of a low titer of M-class antibodies with a good G level is a sign of reactivation of a chronic infection. If only Ig G is positive, the inactive phase of the disease (remission) is diagnosed.

Determination of the duration of infection has prognostic value. If a woman's chronic cytomegalovirus is activated during pregnancy, its dissemination is restrained by pre-existing antibodies. In this case, the risk of intrauterine infection of the fetus is 3-5%. In the case of fresh infection, the transplacental transmission route is observed in almost 60% of pregnant women, which is explained by their lack of protective antibodies and the unhindered spread of the pathogen.

ELISA is not always informative enough to determine the duration of infection. A more reliable result can be obtained by examining the detected G antibodies for avidity to cytomegalovirus. At the same time, the strength of their binding to antibodies is determined.

The more stable the formed immune complexes, the more time has passed since the moment of infection. An avidity higher than 35% indicates that the infection was more than 3 months ago. The indicator of 50-60% is considered a threshold, it speaks of the transition of the disease to the chronic stage. And highly avid antibodies are a sign of carriage or ongoing chronic infection.

Carrier of CMV during pregnancy: what is it?

Carriage of cytomegalovirus is the most commonly diagnosed condition. They say about him when a woman was previously infected, but the pathogen in her body is in an inactive phase. At the same time, she does not show any external signs of the disease, and ELISA shows only the presence of highly avid Ig G.

Carriage does not pose a danger either to a woman or to her developing intrauterine child. Nevertheless, every 4-6 weeks for such a pregnant woman, it is advisable to undergo a second examination to exclude the activation of the virus. Fortunately, most cases of CMV infection do not flare up during pregnancy.

How to treat cytomegalovirus during pregnancy?

Whether treatment of cytomegalovirus will be carried out during pregnancy depends on the activity of the process, the duration of the infection and the woman's confirmed immunodeficiency.

If the laboratory data obtained indicate infection immediately before conception or at the beginning of the first trimester of gestation, expectant tactics are taken. A dynamic observation of the development of the embryo is established. When there is evidence of a violation of embryogenesis and the appearance of defects, the commission makes a decision on the availability of indications for termination of pregnancy for medical reasons. The procedure is carried out only with the consent of the woman. To confirm infection of the fetus, amniotic fluid can be taken for analysis.

Treatment of CMV during pregnancy is carried out upon receipt of data on a fresh infection (acute phase of the disease) or on the reactivation of an existing virus. Antiviral, vitamin, immunomodulating drugs are prescribed. Immunoglobulins and interferons can also be used. If necessary, symptomatic agents are used to alleviate the woman's condition. In case of damage to internal organs, drugs are introduced into the treatment regimen to correct the arising functional disorders.

Infection with cytomegalovirus in pregnant women is by no means a rare occurrence. But, despite the prevalence and relative availability of tests, many women are not aware of the presence of the disease and cannot adequately assess the risks for their unborn child. Although CMV is included in the TORCH group, even a fresh infection of a pregnant woman does not always lead to fetal damage. In addition, if cytomegalovirus is treated in the early stages of pregnancy, you can quickly transfer the infection to an inactive phase and avoid damage to the placenta and embryo.

If a woman is diagnosed with cytomegalovirus during pregnancy, then it is important to start treatment as soon as possible, since the pathology negatively affects the fetus and leads to termination of pregnancy. If cytomegalovirus is suspected when carrying a baby, a woman regularly takes the necessary tests and is monitored by doctors in order to prevent complications in time.

Features of the disease

(CMVI) is characterized by the presence in the blood of a virus belonging to the genus Cytomegalovirus hominis.

Pathogenic organisms are infectious and, according to statistics, to one degree or another are manifested in every second inhabitant. Not only adults can get CMVI, the virus also actively spreads in the child's body. After the penetration of cytomegalovirus infection on the mucous membranes, it remains in a latent phase for a long period and does not manifest itself in any way until favorable conditions are created for its development.

CMV during pregnancy is of two types: congenital and acquired. With a congenital type of disease, a woman has an acute or chronic cytomegalovirus. In turn, acquired CMV when carrying a baby is manifested in 4 types:

spicy;
hidden;
generalized;
mononucleous.

Causes and methods of infection during pregnancy

Cytomegalovirus infection is sexually transmitted.

Cytomegalovirus in pregnant women manifests itself for various reasons, but the weakened protective functions of the immune system affect the manifestation of an infectious disease. With cytomegalovirus infection, the body of a pregnant woman is affected by pathogenic microorganisms, which begin to actively spread. There are several ways of infection with pathology during pregnancy:

Blood transfusion. CMVI is transmitted to a woman in a position with an infusion of donor blood or its components.
Sexual. Transmission of the virus during intercourse, and it is important to take into account that microorganisms are transmitted not only through vaginal, but also oral and anal contact.
Contact and household. Cytomegalvirus infection enters the body of a pregnant woman through the use of other people's hygiene products or common utensils, which are also used by an infected person.
Airborne. In crowded places or in close contact with an infected person.

With insufficient or improper hygiene by a woman, cytomegalovirus appears, so it is extremely important to wash your hands regularly, especially before eating. CMV is dangerous for the baby, as it is transmitted to him by the transplacental route from an infected mother. Also, the infection is transmitted to the baby after birth through breastfeeding.

Symptoms of the disease

The active spread of the virus damages all internal organs.

Cytomegalovirus infection in pregnant women manifests itself in different ways, depending on the type of disease. A woman does not observe any for a long time, which indicates the strong protective functions of the immune system. As soon as the immune system weakens, the viruses actively act, from which the internal organs and the brain suffer. The following symptoms of cytomegalovirus are distinguished when carrying a baby:

inflammatory processes in the pancreas, kidneys, liver, spleen and other internal organs;
digestive dysfunction;
damage to visual function;
rounding of lymph nodes;
increased body temperature;
malaise and fatigue;
sore throat and dry cough;
headache;
inflammation of the nasal mucosa.

In women, CMVI has a particularly negative effect if it occurs along with herpes, which aggravates the clinical picture.

Possible consequences

Danger to the fetus

Fetal infection occurs through the placenta.

Before getting pregnant, a woman should undergo special tests to be tested for CMV, since the pathology threatens with a difficult outcome. The consequences for the fetus can be very serious. Cytomegalovirus during pregnancy leads to impaired embryogenesis. Also, in the early stages, the disease can provoke abnormal development of the fetus, in which the formation of internal organs is disturbed in the baby. Also, often a child with CMVI in the mother is born prematurely. With transplacental infection, the baby will have the following pathological signs:

yellowing of the skin or the appearance of cyanotic spots on the body;
lingering jaundice;
persistent drowsiness and lack of activity;
low muscle tone, trembling hands and feet;
disturbed sucking and swallowing reflexes;
hearing loss of a neurosensory nature, in which hearing soon decreases;
poor progress in mental development;
signs of an inflammatory process in the lungs and kidneys, colitis, pancreatitis and other pathologies of internal organs and the brain.

If the baby is infected with cytomegalovirus in the last stages of pregnancy or during childbirth, then, as a rule, there is no damage to the internal organs. But all the same, such a child is under increased control, since in the first month of life, symptoms similar to ARVI may appear. In this case, the mother should continue to breastfeed the baby, since breastfeeding provides the baby with protective antibodies that allow the CMV to enter the latent phase. If CMV is reactivated, then nothing threatens the baby.

What is dangerous for a woman?

Inflammatory processes in the female genital organs complicate pregnancy.

If a woman is a carrier of CMV and it begins to actively manifest itself during pregnancy, then this can lead to serious complications. A woman may develop cervical erosion, an inflammatory process in the fallopian tubes or ovaries. CMV poses a particular threat to women who develop herpes at the same time. A missed pregnancy or difficult childbirth can be diagnosed. To prevent such complications, a woman should undergo laboratory tests for pathogenic microorganisms before pregnancy, and if they are found, then it is necessary to treat them, and only then become pregnant.

Pregnancy management

CMV during pregnancy requires regular medical supervision. If pathogenic microorganisms are found in a woman while carrying a baby, then you should carefully monitor your well-being. With an interval of 5 weeks, the woman undergoes the necessary tests for detection. If immunoglobulins are detected, emergency treatment of cytomegalovirus is undertaken. Also, laboratory tests of amniotic fluid are carried out to detect infection of the fetus.

A woman with cytomegalovirus should be especially careful to maintain hygiene and refuse to visit public places such as a bath, swimming pool, sauna. You should also limit communication with young children, since they often carry cytomegalovirus. If cytomegalovirus is detected in a woman's husband or permanent sexual partner, then throughout pregnancy the woman refrains from sexual intercourse. Treatment of CMVI in pregnant women is very similar to therapeutic measures for herpes.

Diagnosis of cytomegalovirus during pregnancy

Laboratory tests will help determine the nature of the infection.

Before starting treatment for cytomegalovirus infection in pregnant women, diagnostic procedures are performed. This will require salivary fluid, a smear or scraping of the genital mucosa, blood or urine. If the study detects specific antibodies to cytomegalovirus, then the presence of infection in the pregnant woman's body is confirmed. The table shows the transcript of the blood test.

Such laboratory and instrumental studies are prescribed, which give a complete picture of the disease:

... Detects a small amount of the virus; for the procedure, a smear is taken from the urethra or cervical canal, blood, urine, saliva.
Cytology. The material is examined under a microscope; the procedure reveals pathological changes at the cellular level.

Ultrasound diagnostics is mandatory, in which doctors determine violations in the development of the unborn baby. To find out the state of health of the unborn baby, amnicentesis is performed, in which the amniotic fluid is sent for research. This diagnostic procedure is performed no earlier than the 21st week of pregnancy.