n Obstetrics and Gynaecology Forum - An update on congenital Cytomegalovirus Infection : review




Counselling regarding congenital CMV infection is challenging as it may have a protracted clinical course from the time of suspected maternal infection until evidence of fetal damage. Gestational age at infection is the strongest predictor of adverse outcome but is often impossible to determine.Fetal infection, confirmed by amniotic fluid PCR, cannot be reliably diagnosed before 20 weeks gestation but this is usually not an issue outside of routine screening programmes. Although a positive PCR confirms fetal infection, it does not have prognostic value in the individual patient and it must be remembered that a negative PCR result is not fully reassuring as the sensitivity is not 100%. Fetal blood parameters, obtained by cordocentesis, are most useful for prognosticating in addition to ultrasound features, but manifestations of fetal damage (particularly central nervous system involvement) may only become apparent late in the third trimester. If imaging features of central nervous system involvement are present, late termination of pregnancy can be considered due to the high likelihood of severe brain damage, in line with the South Africa Termination of Pregnancy Act. A vaccine against CMV would be the best solution to this difficult and unpredictable clinical problem, but a phase III trial is still needed to prove efficacy. Hygiene education is beneficial in primary prevention but has not been implemented widely in South Africa. For secondary prevention or treatment, CMV hyper-immune globulin has not demonstrated efficacy so far. Valaciclovir is currently the most promising drug and careful case selection of infected fetuses without CNS involvement would be prudent.


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