How to prevent cytomegalovirus infection.

Infections during pregnancySome infectious diseases during pregnancy are harmless for the mother, and even usually go unnoticed, while at the same time they can be very dangerous for the unborn child: Meant are mainly the cytomegalovirus or parvo, bacteria such as streptococci or listeria, up to unicellular pathogens such as toxoplasmosis.

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Our experts prof. Dr. Frank Vandenbussche, section head of obstetrics at Helios Klinikum Duisburg, and Dr. Igor Milicevic, senior physician for gynecology and obstetrics at the Helios Klinikum Duisburg, explains everything worth knowing about the topic.

Cytomegalovirus during pregnancy

What is cytomegaly?

Cytomegalovirus, or HCMV (human cytomegaly virus), is a member of the family of Herpes viruses. After infection, it remains in lymphoid tie, meaning lymph nodes, among other places, for life. The viruses are transmitted through nasal secretions, saliva, blood, urine, semen, breast milk, or through the placenta.

So high is the probability of infection

About 50 percent of women have never had an infection with HCMV before pregnancy. About 0.5 to 1 percent of these pregnant women then become infected with the virus during pregnancy. A first-time infection is especially problematic in the first three months. If infection occurs via the placenta and thus for the unborn child, this can lead to severe and permanent damage.

For healthy adults, on the other hand, the cytomegalovirus is usually harmless, but the Prognosis for the unborn child much worse: nowadays in Germany 0.1 percent of children are seriously damaged by cytomegaly even before birth. Transmission often occurs when a sibling in the family brings the virus from outside care and then transmits it via Nasal secretions or urine (diaper change) to the pregnant mother.

About half of pregnant women have had an infection with HCMV before. Re-infection (with an HCMV variant) or re-activation (of the present variants) can occur during pregnancy, but these re-infections are generally less dangerous for the unborn child.

How to recognize an infection?

Children and adults with a good immune system show usually no symptoms. In some cases, however Rhinitis, fatigue, and a rise in liver enzymes occur.

This is how a diagnosis is made

Many gynecologists perform one or more during pregnancy HCMV antibody tests in the blood through. If new antibodies are detected, it must be amed that the mother was infected not long ago.

Sometimes symptoms show up in a Ultrasound examination of the child abnormalities, which gives rise to the suspicion of a childhood infection. It is also possible to take some amniotic fluid and perform a PCR test. This is how the virus can be reliably detected. However, the diagnosis is usually made quite late. Then damage that has already occurred can no longer be reversed.

How to prevent cytomegalovirus infection?

Women can increase the risk of infection by Hygiene measures decrease significantly. These aim to avoid direct contact with nasal secretions and urine of young children. So, plastic gloves when changing diapers, frequent hand washing. It is best if the partner also participates.

These measures are costly and it may feel uncomfortable and sterile to treat your own preschool child this way. However, these measures are extremely effective.

How cytomegalovirus infection is treated?

With high-dose immunoglobulins, a concentrate of antibodies from donor blood, or with antivirals (drugs that inhibit viruses) can be used to fight an active infection and try to prevent the virus from passing to the placenta and baby or causing more damage in the baby. In order to completely prevent the virus from passing to the unborn child, the diagnosis must be made early and therapy must be started early.

How dangerous is HCMV for mother and child??

Problematic is almost only one first-time infection in the first three months of pregnancy. Already during this time, growth retardation or even intrauterine infant death may occur.

More often Damage, however, only after birth and detected with increasing age of the child. Then it is mainly hearing damage, but sometimes also developmental disorders of the brain, leading to mental retardation and spastic paralysis.

Hope for the future?

– The NIPTis an examination of cell-free DNA in maternal blood. It is currently detected in 12. The test is performed at the first week of pregnancy to rule out Down syndrome. Advancement for HCMV can lead to early diagnosis, just when the virus is most dangerous and should be best controlled. – Using Antivirals and/or immunoglobulins women can then be targeted for treatment if they have an active infection in the first three months. – In the 5. month can be prevented by a Amniocentesis and PCR to check whether the virus is detectable in the child or not. In the further course, damage can be shown or ruled out via ultrasound. – The Effectiveness of treatment can be tested and improved more and more.

Parvo in pregnancy

What is parvo?

The parvo B-19 virus can only be blood-forming cells in the bone marrow infect. As a result, children and adults experience a slight drop in blood counts, followed by mild symptoms, while the immune system neutralizes the virus and subsequently causes lifelong immunity.

This immune reaction causes red spots on the skin in children and is known as 5. disease or Ringworm denotes. In people who produce a lot of blood cells, for example because of a genetic hemoglobin defect or after severe blood loss, the virus can multiply, sometimes massively. A "vitiated circle" then develops with sometimes fatal anemia. Thus, it also becomes clear why pregnant women show no or hardly any symptoms in the case of an infection, but their unborn child, which has to quadruple its blood volume in the middle third of pregnancy in a very short time, can be in great danger.

This is the probability of infection

About half of pregnant women have never been infected with parvovirus before becoming pregnant. Infection here as well about 0.5 to 1 percent with the virus during pregnancy.

Nursery school teachers, elementary school teachers, and mothers with older children attending nursery or elementary school have a higher risk of infection. Infection is particularly problematic for the unborn child during the months when the child is producing blood cells at a high rate, i.e., from the 4. until the 7. Month of pregnancy.

Today, 0.1 percent of children in Germany are seriously endangered by parvo B19 before birth.

How to recognize an infection?

Children often have ringworm after infection, with small red spots on the body as well as red cheeks.

Pregnant women have usually no symptoms. Sometimes they complain about joint problems about three weeks after they are infected. The unborn child has at this moment already a certain anemia. Sometimes the immune system can destroy the virus. The unborn child recovers by itself. But sometimes the virus multiplies to such an extent that severe anemia develops, the child stops moving, develops water retention and ultimately dies.

This is how a diagnosis is made

Every now and then there are small outbreaks of ringworm. Pregnant women who have had (even minor) contact then have a Antibody test sensible. It shows whether they are already immune due to previous contact, have not been infected, or have been infected in this pregnancy.

The unborn child can then be Ultrasound examinations The child should be monitored regularly, as increasing anemia can nowadays be associated with Doppler ultrasound measured very precisely. Also Water retention can be detected in the earliest stage. Often, the diagnosis is made rather accidentally, the pregnant woman reports because the child hardly moves or water retention is detected during an ultrasound.

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