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CMV In Pregnancy

CMV In Pregnancy. Leili Chamani. MD. MPH. Specialist In Infectious Diseases Department Of Reproductive Health Avesina Research Center (ARC).

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CMV In Pregnancy

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  1. CMV In Pregnancy Leili Chamani. MD. MPH. Specialist In Infectious Diseases Department Of Reproductive Health Avesina Research Center (ARC)

  2. *The most common vertically transmitted viral infection in the developed world is CMV. *Seropositivity rates in the adult population over 40 years of age world wide are 60%-100%.(possibly due to transmission of virus through breastfeeding, sexual contact and spread from children.)*Seropositivity rates in pregnant women in Australia: 71% *primary infection occuring in 1.5% of these pregnancies.*Intrauterine infection occurs in: 50% of primary maternal CMV infections.*5-10% of infected babies are symptomatic.

  3. Vertical Transmission: • pre-natally(transplacental, in utero acquisition) resulting in congenital CMV infection, • natally(infection acquired during labour and delivery), • or in the immediate post-natalperiod (usually transmitted via the breast milk of CMV- seropositive women).

  4. The associated morbidity and sequelae of CMV vary depending on the: • route of acquisition of infection • timing of infection(esp: first 16 weeks of pregnancy) • and maternal immune status recurrent or non primary maternal infection during pregnancy carries a much lower risk to the fetus

  5. CONGENITAL CMV INFECTION • occurs in0.5–2.0% of all deliveries in the developed world. Inthe USA, this corresponds to approximately 40 000 infants annually • 5%-10% of these infantshave clinical evidence of the disease at birth

  6. CytomegalicInclusion Disease (CID) Of The Newborn • visceral organomegaly, • microcephaly withintracranial calcifications, • chorioretinitis • skinmanifestations including petechiae and purpura. • and virtually all babies with this condition have profound neuro-developmental handicap, including mental retardation and sensorineural deafness.

  7. PERINATAL CMV INFECTION May occur by one of three routes: • Exposure to CMV in the birth canal; • Transmission by blood transfusion; • Transmission by breast-feeding (in premature infants can produce life-threatening disease)

  8. Diagnosis • Maternal infection: *Serology: seroconvertion or a 4 fold increase in CMV-IgG Titer. IgM= Best maternal screening test(primary infection & recurrence) *Culture: Urine, Saliva, Cervicovaginal secretions. • Fetal infection: Isolation the virus from amniotic fluid Amniotic fluid PCR(Weeks 21-23) Cord blood CMV-IgM(neither sensitive,nor specific)

  9. Diagnosis: • Women seroposirive for CMV befor conception: No more lab tests needed, unless particular clinical conditions • Pregnant women seronegative for CMV befor conception: Months 2-4 of gestation automated test for CMV-spesific IgG Positive result = seroconvertion = primary maternal infetion • Pregnant women with unknown pre- conception serological status for CMV: Months 2- 4 of gestation: automated test for CMV- specific IgG and IgM Positive IgM (<18 weeks= infected newborn.) Avidity for CMV-IgG Type of infection: a.Primary=low b.recurrent=high c.undefined Avidity:Reactivity to different CMV proteins

  10. Findings in the fetus • Oligohydramnios or polyhydramnios • Non-immune hydrops • Fetal asctis • Intrauterine growth retardation • Microcephaly • Cerebral ventriculomegaly or hydrocephalus • Intracranial calcifications • Pleral or pericardial effusion • Hepatomegaly • Intrahepatic calcifications • Pseudomeconium ileus

  11. Strategies for: Preventing CongenitalCMV Infection A-Cytomegalovirus vaccines currently in clinical trial evaluation * Live, attenuated vaccines Towne Vaccine Towne–Toledo ‘chimera’ vaccines*Subunit vaccines Glycoprotein B (gB) protein subunit canarypox-gB (ALVAC) canarypox-pp65 (ALVAC)vaccines Additional data are needed B-Monitoring ForCMV Infection Durig Pregnancy C-Strict hygene practices for seronegative women

  12. Strategies for Management of CongenitalCMV Infections • Antiviral Therapy For Prevention AndTreatment Of Neonatal CMV Infections * Ganciclovir remains the gold standard, but concerns about its myelosuppressive effect and a lack of data about safety during pregnancy have limited its evaluation for perinatally acquired CMV infections. * Ganciclovir treatment of symptomatic CMV infection with CNS involvement in neonates was shown, in a controlledclinical trial, to improve hearing outcomes • Screening For Neonatal CMV Infections Virus isolation & culture long lasting CMV- Igm in child blood Additional data are needed

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