Spontaneous abortus caused by activation of cytomegaloviral infection: Therapeutic approaches and issues

Abstract

Objective. Immunotherapy of spontaneous aborts in women with long-term reactivation of cytomegalovirus infection - CMVI (positive serum anti-CMV IgM in repeated ELISA during more than one year).

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Methods. 62 women (aged 20-38 years) with anamnesis of spontaneous aborts (at least two) associated with CMVI reactivation had lymphopenia, increasing of big granulocytes count and circulating immune complexes concentrations, reducing of В-cell, T-cell (manly because of Ts-subpopulation) amounts and phagocytosis activity in comparison with 646healthy subjects (p<0.010). Patients, in dependence of clinical features, were treated by different combinations of immunomodulators (T-activin, thymogen, vilosen, sodium nucleonatis), enterosorbents and stimulating procedures (vitamins) for 6-12 months. The criteria for pregnancy planning were: 1. obvious tendency to immune parameters normalization: 2. anti-CMV IgM elimination from patient’s serum.

Results. 60 women became pregnant and 3 of them had spontaneous aborts again. Other 57 women had significantly reduced incidences of gestational complications such as threatened aborts (p=0.001), fetal hypoxia (p<0.001) and gestosis (p<0.001) in comparison with untreated women. There were no cases of intrauterine complications, antenatal death and inborn abnormalities. All of 57 women delivered alive babies on 38-40 weeks of gestation with Apgar scores 8-9.

Conclusion. Described approaches of investigation and therapy were enough to correct disturbances in reproductive function (95% of cases) associated with cytomegaloviral infection reactivation.