Cytomegalovirus in pregnancy

Cytomegalovirus during pregnancy is a fairly common infection that is found in many women. Consider the main causes of cytomegalovirus infection, symptomatology and what kind of danger it poses in the period of gestation.

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

Statistics argue that of 1000-750 children one with CMV, which is congenital or develops after birth. The congenital form of the cytomegalovirus can be acute or chronic. But the acquired CMV is latent, generalized and acute mononucleoside. The incubation period is not known until now, the diagnosis is complicated by an unexpressed clinical picture. In the medical literature indicate a period of 20-60 days before the appearance of the first symptoms of cytomegalovirus.

• If a person has a normal immune system, the disease takes a latent form. That is, the infection can be in the body for many years and do not make itself felt until the immune system reduces its protective properties. One of the reasons for the decrease in immunity is pregnancy.
• Mononucleosis-like CMV occurs in pregnant women with a weakened body. The main signs of infection: weakness, fever, muscle pains, chills, enlarged lymph nodes. Most often, the disease does not bear serious consequences for the body, since the protective properties of immunity cope with the pathogen and cytomegalovirus becomes latent.
• Cytomegalovirus hepatitis is very rare. This form of the disease causes yellowness of the skin and sclera, changes in the color of urine and stool. In addition, there are biochemical signs of the disease, namely an increase in hepatic enzymes. The acute course of infection passes through the week and takes a latent form.
• The generalized form, occurs in children under three months of age, patients with the immunodeficiency virus, and also after organ transplantation or blood transfusion. The disease proceeds very hard, causing damage to the lungs, kidneys, gastrointestinal tract and nervous system.

Very often CMVI occurs simultaneously with an acute respiratory infection. The main symptoms are general malaise, increased fatigue and weakness, low fever, runny nose and sore throat. If a woman underwent CMV during pregnancy, intrauterine infection occurs. But, despite this, only 5% of the fetuses suffer from cytomegaly.

All cases of congenital infection are considered dangerous. If a woman suffered a cytomegalovirus injury in the early stages of pregnancy, it could lead to fetal death and spontaneous miscarriage. In late gestation, congenital CMVI leads to hemorrhagic syndrome, which is accompanied by hemorrhages in the tissues and internal organs. Sometimes, a congenital infection manifests itself several years after the birth of the baby. The child has hearing impairments and developmental lag. Possible fibrosis of internal organs and motor disorders. The main feature of cytomegalovirus infection is that it exhibits other lesions of the newborn's body: immunodeficiencies, hemolytic disease and others.

[1]

The causes of cytomegalovirus in pregnancy

The causes of cytomegalovirus in pregnancy are diverse, but they are all related to the weakened protective functions of the woman's immune system. First of all, it is worthwhile to know that CMV is congenital and acquired. The congenital form can be acute and chronic. And acquired - hidden, acute, generalized or mononucleic. There are several ways of transferring CMV from person to person, that is, the causes of infection with cytomegalovirus during pregnancy:

• Air-dropping.
• Contact or household - infection occurs only if the virus is in an active form. Infection enters the body through saliva during a kiss, when using someone else's toothbrush and even through the dishes.
• Transplacental - represents a danger to the fetus and the normal course of pregnancy. Infection is possible and when passing a baby through the birth canal (if the child is full, then there is no danger). The breast milk of a sick mother can also cause infection of the baby.
• Sexual - the main way of infection among the adult population. The virus enters the body during genital, oral or anal contact without the use of a condom.
• With poor hygiene - cytomegalovirus can get into the human body upon contact with urine or stools containing CMV. Hand hygiene is of particular importance, because the virus gets into the mouth due to poorly washed hands.
• Hemotransfusion - infection with infection occurs when the donor's blood and its components are transfused, using donor eggs or when transplanting organs and tissues.

From 45% of people in the world have antibodies to CMV infection, that is they are seropositive. The older the person, the higher the likelihood that he has immunity to cytomegalovirus. In Switzerland, about 45% of the population is seropositive to infection, in Japan about 96%, but in Ukraine from 80-90%. Primary CMV is manifested in 6-12 years, that is, in childhood. In this case, the infection can have a latent nature, that is, get into the baby's body during breastfeeding, during passage through the birth canal and other. The causes of cytomegalovirus in pregnancy are diverse, since the infection can be in the blood, sperm, urine, saliva, tears and even in a vaginal secret.

How does cytomegalovirus affect pregnancy?

As cytomegalovirus affects pregnancy, and to what extent it is dangerous to infect CMV is a matter of interest to many expectant mothers. During pregnancy, the woman's immune system is significantly weakened. This happens for understandable reasons, so that the body does not reject the embryo (since it perceives it as a foreign object). During this period, the risk of infection with cytomegalovirus infection increases. If the virus is in the body in a latent state, then during the gestation period, it becomes more active and exacerbated.

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

If a pregnant woman becomes infected with CMV in the first trimester of pregnancy, this leads to sudden miscarriages, stillborn and unresolved. If the baby survives or the infection occurs in the late gestation period, the child receives an innate cytomegalovirus infection that manifests itself immediately after birth or in the first years of life. The symptomatology of CMV during pregnancy is manifested as fever, general malaise and weakness, or none at all.

• The main danger of the virus is that it can not make itself felt, that is, it is asymptomatic. In this case, you can identify the infection by the results of blood tests. Since cytomegalovirus penetrates the placental barrier, it belongs to a group of diseases that a woman needs to undergo testing at the child's planning stage.
• Cytomegalovirus can cause severe pregnancy. Very often, the infection causes miscarriages and premature detachment of the placenta. In addition, the risk of fetal hypoxia increases, which leads to incorrect development and premature birth.
• If a woman received CMV during pregnancy, and the virus caused serious complications, an artificial termination of pregnancy occurs. But before that, doctors conduct a deep virological study to study the placenta and fetus. Since even in the most critical situations, there is a chance to save the child.
• Especially dangerous is cytomegalovirus during pregnancy, which occurs along with herpes, rubella or toxoplasmosis. In this case, the consequences of infection will adversely affect both the state of the future mother and the child.

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

• Ultrasonography

It allows to reveal anomalies in the development of the fetus, which are caused by cytomegalovirus: microcephaly, intrauterine growth retardation, ascites, hypochlorism, anomalies in the development of the brain.

• Amniocentesis

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

• The amount of DNA cytomegalovirus <10 * 3 copies / ml - 80% chance that the future baby is healthy.
• The amount of DNA cytomegalovirus ≥10 * 3 copies / ml - 100% chance that the virus penetrated the fetus.
• The amount of cytomegalovirus DNA <10 * 5 copies / ml is 90% probability of the absence of CMV symptoms in the child at birth.
• The amount of DNA cytomegalovirus ≥10 * 5 copies / ml - the probability of a child with symptomatic congenital CMV and pathologies caused by the virus is high. In this case, the doctor may prescribe an abortion.

But do not panic in advance, because not always infected with cytomegalovirus, the child has complications for health. All children with CMV are under constant follow-up. However, in some cases, the virus, affecting the fetus in the womb, causes its death. Some infected newborns begin serious pathologies in their physical and mental development.

Symptoms of cytomegalovirus in pregnancy

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

• In women, cytomegalovirus causes erosion of the cervix, inflammation of the fallopian tubes and ovaries, and cervicitis. The inflammatory process can affect the ovaries, accompanied by severe pain in the lower abdomen and whitish-bluish secretions. In pregnant women, the infection can be asymptomatic.
• In men, CMV causes cold symptoms, which are accompanied by inflammation of the urogenital system. Diseases of the urethra and testicular tissue can be exacerbated. Because of cytomegalovirus with urination, a man feels pain and discomfort
• Consider the general symptoms of cytomegalovirus in pregnancy, which is usually determined by differential diagnosis:
• Acute respiratory viral infection - a woman complains of weakness, fatigue and general malaise, frequent headaches, inflammation of the salivary glands, increased sweating, whitish coating in the tongue and gums.
• The defeat of the genitourinary system - symptoms of a chronic nonspecific inflammatory process are manifested. If doctors can not establish the viral nature of pathological symptoms, antibiotic therapy is conducted, which, as a rule, does not give the expected results.
• If a woman has a generalized form of cytomegalovirus infection, then she is accompanied by the defeat of internal parenchymal organs. Most often there is inflammation of the adrenal glands, kidneys, pancreas, spleen. Because of this, the first look is caused by uncaused bronchitis and pneumonia, which are difficult to treat with antibiotics.
• Cytomegalovirus infection is accompanied by a significant decrease in the immune status, a decrease in platelets. Possible damage to the walls of the intestine, peripheral nerves, vessels of the eyes and brain. It is not uncommon for cases of enlargement of submandibular and parotid salivary glands, skin rash and exacerbation of inflammatory diseases of the joints.

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

Cytomegalovirus penetrates into mononuclear phagocytes and leukocytes and is susceptible to replication. Infected cells multiply, increase in size and carry virus inclusions in their nuclei. All this suggests that CMV can remain in the latent state long enough, especially if lesions have been lymphoid organs. The duration of the disease can be from 10 to 20 days.

Consequences of cytomegalovirus in pregnancy

The effects of cytomegalovirus during pregnancy can be fatal for a child. That is why every woman should undergo a CTM examination before conception. This will make it possible to know whether it is worth to fear or simply to strengthen the immune system. Consequences can make themselves felt in both primary cytomegalovirus infection and transplacental infection.

The maximum danger to the fetus occurs in the first 4-23 weeks of pregnancy. The minimal danger to the future of the child occurs when the CMV is reactivated during the gestation period. At the same time, every woman should remember how serious the consequences of cytomegalovirus in pregnancy can be. CMV in a future mother can cause the following pathologies in a child:

• Fetal death, frozen pregnancy, premature detachment of the placenta and artificial birth.
• Heart defects and cardiovascular pathology.
• Loss or hearing and vision impairment.
• Mental retardation and an underdeveloped brain.
• Hepatitis, enlarged liver, jaundice.
• Pathological lesions of the central nervous system.
• Pathology of the musculoskeletal system.
• Increased spleen and liver.
• Intracerebral calcifications, microcephaly.
• Petechia, dropsy, cramps.
• Ventriculomegaly and others.

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

[2], [3],

Diagnosis of cytomegalovirus in pregnancy

Diagnosis of cytomegalovirus during pregnancy should be carried out at the planning stage of conception. To identify the virus, a blood, urine, saliva, scraping and swab from the genitals are examined. During pregnancy, CMV is detected by a blood test. Diagnosis of infection is difficult because of a fuzzy clinical picture. Therefore, tests are performed to detect antibodies. If the analysis revealed the presence of specific antibodies to CMV, then this indicates the presence of the virus in the body.

The main methods of diagnosis of cytomegalovirus:

• Cytological - reveals enlarged cells in breast milk, urine sediment, in saliva and other secretory fluids.
• Serological - antibodies of cytomegalovirus are detected with the help of immunoglobulins IgG and IgM. If a pregnant woman has IgM, then this indicates a recent infection, which requires detailed study. Conduct an analysis of umbilical cord blood of the embryo for detection of immunoglobulins. If the test shows IgM, then this indicates that the child is infected with CMV.
• Molecular-biological - is carried out for the detection of cytomegalovirus DNA in the cells of the body.
• Virological is a rather expensive and time-consuming method of diagnosis. To conduct it, the pathogen is cultivated on its nutrient medium.

Of all the above-described method of diagnosis, the most commonly used serological. If there are antibodies to the cytomegalovirus in the blood, that is, igg is positive, this indicates a high immunity in the pregnant woman. In most cases, CMV is latent.

With negative diagnosis of cytomegalovirus, pregnant women are recommended to conduct a study every trimester, as future mothers are classified as a risk. In any case, the absence of antibodies is a potential threat to a normal pregnancy. Babies born from a sick mother are obliged to undergo diagnostics in the first days of life for the presence of antibodies. However, if a newborn has been found IgG antibodies in the first three months, then this is not a sign of congenital cytomegalovirus. But the presence of IgM indicates an acute CMVI.

[4], [5], [6],

Analysis for cytomegalovirus in pregnancy

Analysis of cytomegalovirus during pregnancy is mandatory for every future mother. This is because the infection of CMV in the first 20 weeks of pregnancy can lead to miscarriage and death of the fetus. But in the last months of gestation cytomegalovirus is very dangerous. Therefore, to avoid the severe consequences of the disease, each woman gives an analysis for cytomegalovirus.

Laboratory diagnosis of CMV consists of a study of urine and saliva, polymerase chain reaction and serological examination of blood serum. Let's consider each of the analyzes in more detail.

• Cytological examination of the sediment of urine and saliva

Urine and saliva of the pregnant woman is examined under a microscope to detect the characteristic of the CMV of huge cells.

• PCR or polymerase chain reaction

Diagnosis is based on the definition of DNA infection, which is contained in viral cells and is the carrier of hereditary information in blood cells. For conducting PCR use urine, scrapes, sputum or saliva.

• Serological tests of blood serum

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

[7]

The norm of cytomegalovirus in pregnancy

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

To detect antibodies to the virus during pregnancy, a woman is tested for TOCH infection. It is worth noting that when ingested, the virus remains there forever. Only tests for antibodies can reveal the relationship between the body and cytomegalovirus. When deciphering the results of blood tests, special attention should be paid to the following:

Indicators		Avidness	Explanation of results
IgM-	IgG-	Do not define	Seronegativity, the virus is absent in the female body. Nothing threatens the normal development of the fetus.
IgM +	IgG - / +	Low	There is a primary infection with CMV and the risk of infection of the fetus.
IgM +/-	IgG +	Threshold area (average)	Primary infection is at the last stage, the risk of infection of the fetus is high.
IgM-	IgG +	High	Cytomegalovirus is in a latent state, the risk for the fetus is minimal.
IgM +/-	IgG +	Low	CMV at the stage of reactivation, a high risk of infection of the fetus.

Normal IgG is considered normal and no IgM. Such results indicate that the female body has never been in contact with the virus. If IgG is above normal, and IgM is not present, then the woman's organism contains the virus in a latent state. In this case, in the presence of provoking factors and a weakened immune system, the probability of infection of the fetus in the womb or the child during the labor process is minimal. If IgM is higher than normal, the woman survived primary infection, but pregnancy can start the virus again and cause fetal infection.

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

IgG to cytomegalovirus in pregnancy

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

In order to detect the presence of infection, the woman takes blood every trimester and conducts a study for the presence of antibodies IgM. With primary CMV, IgG appears against the background of IgM. If IgG increases and no IgM is detected, this indicates an exacerbation of the cytomegalovirus. If IgG is detected in a small amount, it indicates the presence of a virus in the mother's body, which means there is a risk of infection of the fetus.

• IgG to cytomegalovirus during pregnancy allows to confirm primary infection. At primary infection, antibodies IgG in blood appear later, than IgM and for them low avidity characterizes.
• The IgG antibody assay is part of a complex of laboratory tests for HBV infection. In addition to cytomegalovirus, a woman is tested for herpes infection, rubella and toxoplasmosis.
• In all children up to six months and older, there are IgG antibodies in the blood that are of maternal origin. This makes it difficult to interpret the results of IgG avidity.
• If a woman is sick with immunodeficiency, then the level of antibodies is very low and they can not be determined in the blood. For diagnostics other biological fluids are used and PCR is performed.

Cytomegalovirus IgG positive in pregnancy

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

Positive IgG is necessary for all women who plan a pregnancy. In this case, the risk of serious pathologies in a child when the virus is activated is 0.1%, and for a primary infection of the mother and fetus, 9%. With primary infection, the incubation period and immune reconstruction take from 15-60 days, depending on the course of pregnancy and the individual characteristics of the woman's body.

The protective reaction of the body is based on the production of antibodies IgM and IgG, which are responsible for the lysis and replication of intracellular cytomegalovirus. Cytomegalovirus IgG has averaged values of the norm in ME / ml. So, if the value is more than 1.1, then this indicates the presence of infection in the body. If the indicator is less than 0.9, the result is negative, that is, a woman and the normal course of pregnancy is not threatened.

[8], [9], [10]

IgM to cytomegalovirus in pregnancy

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

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

• The presence of symptoms - if the symptoms of the infection are completely absent, but CMVI is found in the analysis, the antiviral drugs are not prescribed for the pregnant woman.
• The asymptomatic course of CMV is indicative of the high status of the immune system, which alone coped with the infection. In order to speed up the process of producing antibodies, pregnant women are prescribed immunomodulators and vitamins, which have fortifying properties and increase immunity.
• With pronounced symptomatology of cytomegalovirus, a woman undergoes antiviral treatment. Obligatory is vitamin therapy.

Cytomegalovirus IgM positive in pregnancy

Cytomegalovirus IgM is positive in pregnancy, can only be determined using the PCR method or ELISA. Diagnosis with the help of ELISA allows you to identify the presence of antibodies in the blood, that is, the immune system response to an infectious agent. If the pregnant woman has an elevated IgM antibody level, then this indicates a primary infection and an exacerbation of the cytomegalovirus infection. In this case, additional tests are performed to determine the concentration of both immunoglobulins.

A positive result on IgM and IgG indicates a secondary exacerbation of the cytomegalovirus. In 90% of the population, IgG has a positive result and this is considered the norm. But as a result of the analysis with positive IgM, women are not recommended to become pregnant before this titer is normalized. If the condition is diagnosed during the period of gestation, consultation of the gynecologist and medical intervention is required.

A certain amount of IgM acts as an indicator of cytomegalovirus activity. IgM indicates the severity of infection, reinfection or reactivation. If positive IgM is detected in a seronegative patient, then this indicates the primary cause of the disease. Antibodies of IgM appear only with endogenous reactivation of CMV. Timely detection of antibodies allows for complex observation, study of the dynamics of cytomegalovirus and its clinical manifestations. If the pregnant CMV took a severe form, then the development of antibodies is greatly slowed down. This applies to people with a weakened immune system.

[11], [12], [13], [14]

Avidity to cytomegalovirus in pregnancy

Avidity to cytomegalovirus during pregnancy is a kind of evaluation of the ability of antibodies to bind to CMV to neutralize the virus. For the definition of avidity, the ELISA diagnostics are performed. This method of investigation allows to detect the presence of antibodies in the blood, their content and affinity. Avidity is determined by the values of IgG and IgM, which allow you to know about the maturity of antibodies.

Indicators		Avidness	Explanation of results
IgM-	IgG-	Do not define	Seronegativity, the virus is absent in the female body. Nothing threatens the normal development of the fetus.
IgM +	IgG - / +	Low	There is a primary infection with CMV and the risk of infection of the fetus.
IgM +/-	IgG +	Threshold area (average)	Primary infection is at the last stage, the risk of infection of the fetus is high.
IgM-	IgG +	High	Cytomegalovirus is in a latent state, the risk for the fetus is minimal.
IgM +/-	IgG +	Low	CMV at the stage of reactivation, a high risk of infection of the fetus.

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

Data on avidity is an important indicator of the stage of infectious development of cytomegalovirus. If avidity is below 30%, then this indicates the spread of the virus through the body and primary infection. Avidity is more than 60% indicates the past infection, that is, the virus is in a latent state. Avidity at 30-50% is a re-infection or cytomegalovirus is in an active stage.

[15], [16], [17], [18]

Cytomegalovirus in the smear during pregnancy

Cytomegalovirus in the smear during pregnancy can be determined from the first days of conception. And this is not surprising, since CMV belongs to the family of herpesviruses. That is, the DNA of infectious agents, once ingested into the human body, can not be destroyed. You can detect the infection with a smear from the mucous membrane of the vagina or during a primary examination. According to statistics, laboratory tests reveal CMV in every second woman. Such results indicate that the virus is subject to detailed diagnosis, since it can have both a latent and an acute condition.

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

• The risk of infection comes at a time when the body of a pregnant woman is under stress. Reactivate cytomegalovirus can be harmful habits of a woman who adversely affect her health.
• Various chronic diseases and pathologies, long-term treatment or therapy, weakening the immune system, represent a risk of CMV infection. Infection of the child will come inevitably, because the already weakened immune system of a woman can not suppress the virus. Symptomatology of cytomegalovirus is similar to ARVI, only the duration of respiratory infection lasts at least 5-6 weeks.
• The greatest danger of cytomegalovirus is in the first trimester of pregnancy. Since during this period the infection can provoke a miscarriage. When reactivation of CMV on the last stages of pregnancy, placental abruption, frozen pregnancy or premature birth may occur.

But the presence of cytomegalovirus does not always mean that the child will be infected. It depends on the behavior of the pregnant woman, in the smear of which was found CMV. A woman should follow the doctor's instructions and follow all recommendations. As a rule, a woman is prescribed antiviral medications and immunomodulators. From the future mother is required to closely monitor the health, maintain the immune system and eat a healthy balanced diet. Observe these conditions is especially important for women who have cytomegalovirus in a latent state. If the future mother leads a healthy lifestyle and monitors her health, chances are great that the baby will be born healthy and without pathologies caused by cytomegalovirus.

[19], [20], [21]

DNA of cytomegalovirus in pregnancy

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

• There is a generalized and localized form of the disease caused by cytomegalovirus. With a localized form, pathological processes are detected only in saliva, and with a generalized change, all organs and systems are affected.
• CMVI belongs to the group of reproductively dangerous infections that are included in the TORCH-complex (Toxoplasma, Rubella, Cytomegalovirus, Herpes). The examination on TORCH is carried out half a year before pregnancy in order to find out the state of the immune system of the future mother and, if necessary, to conduct immunotherapy and other therapeutic measures.

To diagnose cytomegalovirus DNA and assess the risk of the appearance of the form of CMV, special tests are used: anti-CMV-IgG and anti-CMV-IgM. The material for analysis is blood, and the PCR method reveals viral DNA. If, according to the results of the analysis, a fragment of cytomegalovirus DNA is found in the pregnant woman, this indicates infection. If DNA is not found, this may indicate that there are no DNA fragments or that a biological material with insufficient amount of cytomegalovirus DNA was taken for the study.

[22], [23], [24]

Treatment of cytomegalovirus in pregnancy

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

• Future moms who have found cytomegalovirus, doctors prescribe vitamin and immunomodulating drugs to strengthen the immune system. But such treatment is possible only if CMV is in a passive state.
• To maintain the immune system use herbal teas, natural juices, fruits and vegetables. A pregnant woman should monitor her diet, nutrition should be balanced. The attending physician will help pick up a collection of herbs that will be safe for the child and will not provoke miscarriage, but at the same time will strengthen the woman's immunity.
• If the cytomegalovirus is in the active state, antiviral agents are used for treatment, since vitamins and immunomodulators can not cope with the disease. In this case, the main goal of treatment is to avoid possible complications. Treatment will allow to bear and give birth to a healthy baby without deviations and pathologies.

Very often CMVI is accompanied by symptoms of ARVI and other associated diseases. In this case, the success of cytomegalovirus treatment depends on the effectiveness of treatment of the lesion. To do this, use antiviral and immunomodulating medications, in conjunction with prescribed medicines for the treatment of the disease. It is strictly forbidden to independently treat cytomegalovirus. Since only a doctor can choose a safe, but effective drug.

Despite the fact that CMV is able to cause serious abnormalities in the development of the fetus, abortion is not carried out in all cases of infection. The doctor can offer this procedure for infection during pregnancy and if ultrasound is found anomalies and pathologies in the development of the fetus, which will lead to disability of the child. Another indication for abortion is the result of the analysis of amniotic fluid, which shows a high risk of developing congenital CMV.

Treatment of cytomegalovirus during pregnancy involves drug therapy. Let's consider the basic medical products used at a cytomegalovirus:

• Human anticytomegaloviral immunoglobulin

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

• Antiviral medicines

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

• Immunomodulators

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

Preventive maintenance of a cytomegalovirus at pregnancy

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

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

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

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

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

Prognosis of cytomegalovirus in pregnancy

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

Cytomegalovirus in pregnancy is dangerous if it is in active form. Because this can cause intrauterine infection of the fetus. If infection occurs early in pregnancy, CMV causes miscarriage, and in later cases serious pathologies. A particular danger is primary infection, in contrast to the activation of a long-existing infection.

Cytomegalovirus in pregnancy is not a direct indication for abortion or caesarean section. The active form of CMV should be alarming, and requires additional examinations.