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Pregnancy and cytomegalovirus

Pregnancy and cytomegalovirus

Question:

- I'm pregnant in 7 weeks. The IAS for the cytomegalovirus virus is 0.719, which means I have been contacting the virus for the last three months. If I contacted the virus in January, and I got pregnant in February, what are the chances that the fetus will be affected?

Answer:

In the situation presented by you there is a difficulty in making a decision. A distance between cytomegalovirus infection and pregnancy at least 6 months is usually indicated, but infection with this virus at the onset of pregnancy or near the onset of pregnancy is not an absolute indication of termination of pregnancy.

15% of pregnant women who do CMV first-trimester pregnancy miscarriage spontaneously, the infection being confined only at the placental level (in fact, a higher frequency of fetal infection was observed in the case of infection than secondary infections).
Later, during pregnancy, placenta infection may be associated with fetal infection.

The virus disseminates hematogen to the placenta, which acts as a reservoir in which CMV replicates before being transmitted to the fetus, at a rate of 25%.

CMV persists in placental tissue long after the virus disappears from the blood. Fetal infection is in most cases asymptomatic, so the diagnosis is rarely made during pregnancy, except in cases where the mother has had a symptomatic CMV infection, serologically confirmed (as in your case).

Symptomatic fetal infection is manifested by: growth retardation, oligoamnios, anasarca, ventricular dilatation, intracerebral calcifications, microcephaly, pericardial effusion, intra-abdominal hyperecogenic images, intrahepatic calcification accompanied by ascites; changes that can be evidenced by fetal morphological ultrasound and / or fetal MRI.
This infection can lead to the death of the fetus in utero as well. In conclusion, I recommend that you go back to the obstetrics and gynecology practice to reevaluate the case and determine the subsequent conduct.

The final decision I advise you to take after discussing with the obstetrician the risks involved in associating pregnancy with any CMV infection in your case.

Good health!

Dr. Ciprian Pop-Began - Obstetrics and Gynecology - Clinical Hospital of Obstetrics-Gynecology Prof. Dr. Panait Sarbu