Context.-The impact of viral infections during pregnancy on adverse pregnancy outcomes is not understood fully.
Objective.-To assess the frequency of parvovirus B19, herpes simplex 2, and cytomegalovirus infections in relation to late abortions, in sera from Egyptian pregnant women to establish basic knowledge for future pregnancy care. In addition, to study the diagnostic value of specific im-munoglobulin M (IgM) against those viruses compared with their genomes detection by polymerase chain reaction in maternal serum as a noninvasive method of laboratory diagnosis.
Design.-Patients were recruited at the Women’s Clinic, Mansoura University. One group of patients with recurrent spontaneous abortions (RSA) and a second group of pregnant women without a history of RSA were evaluated including demographic, medical, and clinical data. Virologic markers were evaluated for specific IgM and for viral DNA to cytomegalovirus, herpes simplex virus 2, and parvovirus B19.
Results.-There was a statistically significant difference between the RSA group and the pregnant women without RSA group in frequency of parvovirus IgM (84% and 16.7%, respectively) (P
Conclusions.-From this study, we conclude that viral infections with parvovirus B19 and herpes simplex 2 were frequently associated with recurrent abortions, and careful investigation for this condition must include evaluating these patients for the previously mentioned viruses. Serologic study by specific IgM for parvovirus and herpes simplex seem to be reliable as screening tests for high-risk pregnancy.
(Arch Pathol Lab Med. 2007;131:956-960)
Some evidence suggests that intrauterine infections play a major role in the pathogenesis of early pregnancy loss, but the implication and prevalence of microorganisms in the etiology of spontaneous abortion during the first trimester of pregnancy has not yet been well established.1
Cytomegalovirus (CMV) and parvovirus B19 are linked to both late abortion and stillbirth.2,3 Parvovirus B19 infections are associated with different clinical manifestations that vary from asymptomatic to severe symptoms. The main clinical manifestations are erythema infectios-um, transient aplastic crisis in individuals with hemoglo-binopathies, chronic anemia in the immunocompromised patients, acute polyarthralgia syndrome in adults, hy-drops fetalis, spontaneous abortion, and stillbirth.4,5
Because B19 infection has been associated with a wide variety of clinical manifestations and some clinical features of B19 infection such as anemia or rash can be common to other pathogens, a specific laboratory identification of B19 is required and any diagnostic tool must consider both the type of pathology and the type of patient. In immunocompetent individuals, virologic and serologic testing are complementary, whereas in immunocompro-mised patients viral detection is the test of choice.
Today, viral detection is generally based on direct detection of the B19 genome in clinical samples.6
Another virus that could be implicated in recurrent abortion is herpes simplex. Genital herpes is the result of infection by herpes simplex virus type 2 (HSV-2) and to a lesser extent HSV type 1 (HSV-1). Recently there has been a rise in the prevalence of genital HSV infections in both industrialized and developing countries. The main factors attributed to the spread of HSV include asymptomatic virus shedding and underrecognition and underdiagnosis of the disease. At the level of the individual patient, genital herpes is associated with significant psychological morbidity and complications such as neonatal herpes, the result of transmission of HSV from mother to baby.7 The incidence of asymptomatic cervical HSV-2 infections was considerably higher in patients with a history of spontaneous abortion with a possible etiologic connection between HSV and spontaneous abortion.8
Serologic assays were not very useful for the elucidation of the role of HSV in inducing spontaneous abortions, although they indicate that the state of pregnancy predisposes to HSV reactivation.9
The objectives of this study were to evaluate the role of infections with parvovirus B19, HSV-2, and CMV in recurrent abortions and to study the diagnostic value of specific immunoglobulin (Ig) M against those viruses compared with detecting the presence of their genomes by polymerase chain reaction (PCR) in maternal serum.
MATERIALS AND METHODS
Patients
The patients were recruited from an obstetric outpatient clinic at the Mansoura University Hospital. Two different groups were evaluated. The first group (n = 50) consisted of patients with medically unexplained recurrent spontaneous abortions (RSA) (women with a history of 3 or more consecutive spontaneous abortions including abortions up to 22 gestational weeks). The second group (n = 12) consisted of pregnant women without a history of RSA and with pregnancy duration of more than 32 weeks’ gestation. The demographic, medical, and clinical data were collected in each case based on personal interviews and medical examination.
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