If an expectant mother is found to have primary CMV infection, her care should be handled by a high-risk-pregnancy specialist who can closely monitor the fetus, as hydrops fetalis and fetal death are possibilities.5An amniocentesis should be done after 7 weeks of suspected infection but after 20 weeks’ gestation. Amniotic fluid, not fetal serum, should be tested by polymerase chain reaction (PCR) method for CMV infection, because higher levels of virus are excreted by the fetal kidneys through the urine into the amniotic fluid. However the renal system in the fetus is not functional until after 20 weeks, so the procedure cannot be performed until after this time.
Regardless of the results of the amniocentesis, the infant’s urine should be tested by viral culture and PCR shortly after birth and within the first 3 weeks of life for proper diagnosis of congenital infection.5
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Treatment options
Although there is currently no cure for cCMV, trials have shown benefit from maternal, and at times fetal, transfusions of CMV-specific intravenous immunoglobulin (IVIG),12and this should be offered to parents as an option. Further, a study done by Maidji and colleagues in 2010 demonstrated that IVIG transfusions received by the mother resulted in improved placental vasculature, reduced placental viral replication, and decreased necrotic villi. This in turn improved blood flow and nutrient delivery to the fetus.10
Providers should offer parents of infants born with symptomatic cCMV the option to treat the newborn with intravenous ganciclovir or oral valganciclovir to help reduce the incidence of progressive hearing loss.6Although the clinician should make clear to the parents that this is not a cure and will not reverse any neurologic damage, these treatments have been associated with some neurodevelopmental improvement.3
