Question

How will you manage a suspected case of maternal primary cytomegalovirus infection in pregnancy?

Hint:

Early diagnosis of primary CMV infection and monitoring the fetus through ultrasound and amniocentesis are crucial for managing maternal CMV infection in pregnancy.

Answer 1

Step 1: Management of Maternal Primary Cytomegalovirus (CMV) Infection in Pregnancy.
Primary CMV infection during pregnancy can lead to congenital CMV in the fetus, which can result in significant neurological and sensorineural complications. Management focuses on diagnosis, maternal monitoring, and reducing the risk of fetal transmission. Steps include:
(1) Diagnosis of Maternal CMV Infection: - Serological Testing: The first step is to confirm the diagnosis of primary CMV infection by testing for IgM antibodies (indicating recent infection) and IgG avidity testing (low avidity suggests recent infection).
- Polymerase Chain Reaction (PCR) Test: PCR testing of maternal blood or urine can confirm active infection by detecting the CMV DNA.
- Amniocentesis for Fetal CMV Testing: If primary infection is confirmed, amniocentesis can be performed to detect CMV DNA in the amniotic fluid. This helps in assessing fetal infection and determining the need for further management.
(2) Monitoring Maternal Health: - Maternal Ultrasound: Regular ultrasound scans are recommended to monitor for signs of fetal growth restriction, hydrops fetalis, or brain abnormalities like ventriculomegaly or intracranial calcifications.
- Regular Blood Tests: Monitor for any maternal complications such as thrombocytopenia or liver dysfunction.
(3) Management of Fetal Infection: - Antiviral Therapy: Valganciclovir or ganciclovir may be considered in certain cases, especially if the fetus is diagnosed with CMV infection via amniocentesis. However, the use of antivirals is still a subject of research, and its benefits are not fully established in routine practice.
(4) Counseling and Support: - Prenatal Counseling: Offer genetic counseling to inform the mother of the potential risks to the fetus and the possible outcomes, including hearing loss, vision problems, and neurodevelopmental delays.
- Infection Control: Advise on hygiene practices to reduce the risk of transmission to others, especially neonates and immunocompromised individuals.
(5) Postnatal Management: - If the baby is born with congenital CMV, management involves monitoring for sensorineural hearing loss, neurological deficits, and developmental milestones. Early intervention such as auditory screening and neurodevelopmental assessments are essential.
- Antiviral Treatment: In infants diagnosed with congenital CMV, treatment with ganciclovir or valganciclovir may be offered to reduce the risk of further complications.