CMV infection: prognostic factors
Faculty of Medicine and Health Sciences
Proceedings of the 8th world congress of perinatal medicine
8th World Congress of Perinatal Medicine, SEP 09-13, 2007, Florence, ITALY
, p. 157-160
University of Antwerp
Infection before 20 weeks seems to have a worse prognosis. The maternal immune response, placental permeability, intraplacental viral proliferation with transient placental insufficiency, virulence of the viral strain, viral load and the fetal immune respons can alter transmission and disease rate. Ultrasound nor MRI can exclude a severely affected child. The sensitivity of PCR on amniotic fluid is influenced by the test used, the time since infection, gestational age and viral load, making comparisons difficult and explaining contradictory results on a viral load cut off to predict fetal disease. PCR on fetal cells in maternal blood has been reported once but has not yet been reproduced. Ganciclovir and foscarnet have serious side effects, valaciclovir has less side effects, shows good penetration to the fetal compartment and improved outcome is suggested in an uncontrolled study. CMV immunoglobulin has also shown promising results in a non-randomised study. Vaccination probably has to stimulate both a humoral and a cellular C4-CD8 immune response, but is far from available.