The challenges of managing CMV infection during pregnancy

CASE Anomalous findings on fetal anatomic surveyA 27-year-old previously healthy primigravid woman is at 18 weeks' gestation.She is a firstgrade schoolteacher.On her fetal anatomic survey, the estimated fetal weight was in the eighth percentile.Echogenic bowel and a small amount of ascitic fluid were noted in the fetal abdomen.The lateral and third ventricles were mildly dilated, the head circumference was 2 standard deviations below normal, and the placenta was slightly thickened and edematous.• What is the most likely diagnosis?• What diagnostic tests are indicated?• What management options are available for this patient?C ytomegalovirus (CMV) is the most common of the perinatally transmitted infections, affecting 1% to 4% of all pregnancies.Although the virus typically causes either asymptomatic infection or only mild illness in immunocompetent individuals, it can cause life-threatening disease in immunocompromised persons and in the developing fetus.In this article, we review the virology and epidemiology of CMV infection and then focus on the key methods to diagnose infection in the mother and fetus.We conclude by considering measures that may be of at least modest value in treating CMV in pregnancy. Virology of CMV infectionCytomegalovirus is a double-stranded DNA virus in the Herpesviridae family.This ubiquitous virus is present in virtually all secretions and excretions of an infected host, including blood, urine, saliva, breast milk, genital secretions, and tissues and organs used for donation.Infection is transmitted through direct contact with any of the substances listed; contact with infected urine or saliva is the most common mode of transmission.Disease occurrence does not show seasonal variation.After exposure, an incubation period of 28 to 60 days ensues, followed by development of viremia and clinical symptoms.In the