{"id":2528,"date":"2023-06-02T00:00:00","date_gmt":"2023-06-01T21:00:00","guid":{"rendered":"https:\/\/gynaikologos-komotini.gr\/?p=2528"},"modified":"2026-10-17T20:10:06","modified_gmt":"2026-10-17T17:10:06","slug":"gebelikte-sitomegalovirus-cmv-enfeksiyonu","status":"publish","type":"post","link":"https:\/\/gynaikologos-komotini.gr\/tr\/gebelikte-sitomegalovirus-cmv-enfeksiyonu\/","title":{"rendered":"Gebelikte Sitomegalovir\u00fcs (CMV) Enfeksiyonu"},"content":{"rendered":"\t\t
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Primer enfeksiyondan sonra vir\u00fcs, konak h\u00fccrelerde latent (gizli) durumda kal\u0131r ve daha sonra yeniden aktive olabilir. Ayr\u0131ca farkl\u0131 bir viral su\u015fla yeniden enfeksiyon geli\u015febilir (primer olmayan veya sekonder enfeksiyon).\"\"<\/p>

Gebelerde primer CMV enfeksiyonu g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 yakla\u015f\u0131k %1\u20132, transplasental yolla fet\u00fcse bula\u015fma oran\u0131 ise %32’dir. Primer olmayan enfeksiyonun g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 yakla\u015f\u0131k %21,5 olup fet\u00fcse bula\u015fma oran\u0131 %3,5’in alt\u0131ndad\u0131r.<\/p>

CMV, yenido\u011fanlarda en s\u0131k g\u00f6r\u00fclen konjenital enfeksiyondur ve bildirilen s\u0131kl\u0131\u011f\u0131 %0,2\u20132,2 aras\u0131nda de\u011fi\u015fmektedir.<\/p>

Bula\u015fma, gebelik s\u0131ras\u0131nda plasenta yoluyla (fet\u00fcs ve yenido\u011fanda klinik a\u00e7\u0131dan \u00f6nemli komplikasyonlar\u0131n ba\u015fl\u0131ca nedeni), do\u011fum s\u0131ras\u0131nda enfekte servikal salg\u0131larla temas sonucu veya emzirme yoluyla ger\u00e7ekle\u015febilir. Do\u011fum s\u0131ras\u0131nda ya da anne s\u00fct\u00fcyle edinilen enfeksiyonlar genellikle asemptomatiktir veya \u00e7ok hafif klinik sonu\u00e7lara neden olur.<\/p>

Transplasental bula\u015fma olas\u0131l\u0131\u011f\u0131 gebelik haftas\u0131 ilerledik\u00e7e artarken, primer maternal enfeksiyon gebeli\u011fin erken d\u00f6nemlerinde meydana geldi\u011finde klinik bulgular\u0131n \u015fiddeti daha fazla olmaktad\u0131r.<\/p>

Gebelik trimesterlerine g\u00f6re transplasental bula\u015fma oranlar\u0131:<\/p>

  • Birinci trimester: yakla\u015f\u0131k %30.<\/p><\/div><\/div><\/li>

  • \u0130kinci trimester: %34\u201338.<\/p><\/div><\/div><\/li>

  • \u00dc\u00e7\u00fcnc\u00fc trimester: %40\u201372.<\/p><\/div><\/div><\/li><\/ul>

    Primer maternal enfeksiyon sonras\u0131nda enfekte olan fet\u00fcslerin yakla\u015f\u0131k %12\u201318’i do\u011fumda semptomatik olacakt\u0131r. Bu yenido\u011fanlar\u0131n %25’inde uzun d\u00f6nem komplikasyonlar geli\u015fecektir.<\/p>

    A\u011f\u0131r enfeksiyonu olan bebeklerin yakla\u015f\u0131k %30’u ya\u015fam\u0131n\u0131 kaybederken, %65\u201380’inde n\u00f6rolojik komplikasyonlar geli\u015fmektedir.<\/p>

    Primer olmayan maternal CMV enfeksiyonlar\u0131nda sens\u00f6rin\u00f6ral i\u015fitme kayb\u0131 en ciddi komplikasyondur.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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    Hijyen \u00d6nlemleriyle Sitomegalovir\u00fcs (CMV) Enfeksiyonunun Primer \u00d6nlenmesi<\/h4>

    Primer korunman\u0131n amac\u0131, \u00f6zellikle gebelik \u00f6ncesinde ve gebelik s\u0131ras\u0131nda kad\u0131nlar\u0131n sitomegalovir\u00fcse (CMV) maruz kalma olas\u0131l\u0131\u011f\u0131n\u0131 azaltmakt\u0131r.<\/p>

    Gebelik \u00f6ncesinde ve gebeli\u011fin erken d\u00f6neminde seronegatif kad\u0131nlar<\/strong><\/p>

    K\u00fc\u00e7\u00fck \u00e7ocuklarla yak\u0131n temas, CMV bula\u015f\u0131n\u0131n \u00f6nemli kaynaklar\u0131ndan biridir. \u00c7ocuklar, belirtiler ortadan kalkt\u0131ktan sonra bile vir\u00fcs\u00fc aylar boyunca idrar ve t\u00fck\u00fcr\u00fck yoluyla yayabilirler.<\/p>

    \u00d6zellikle iki ya\u015f\u0131ndan k\u00fc\u00e7\u00fck \u00e7ocuklarla aile ortam\u0131nda veya mesleki nedenlerle s\u0131k temas eden seronegatif kad\u0131nlarda primer CMV enfeksiyonu riski artmaktad\u0131r.<\/p>

    Korunma temel olarak basit ki\u015fisel hijyen \u00f6nlemlerine dayan\u0131r. Bunlar aras\u0131nda bez de\u011fi\u015ftirdikten veya \u00e7ocuklar\u0131n t\u00fck\u00fcr\u00fc\u011f\u00fc ve idrar\u0131yla temas ettikten sonra ellerin iyice y\u0131kanmas\u0131, yemek kaplar\u0131n\u0131n ve \u00e7atal-ka\u015f\u0131k gibi gere\u00e7lerin ortak kullan\u0131lmamas\u0131 ve k\u00fc\u00e7\u00fck \u00e7ocuklar\u0131n a\u011f\u0131zdan \u00f6p\u00fclmesinden ka\u00e7\u0131n\u0131lmas\u0131 yer almaktad\u0131r.<\/p>

    CMV’ye kar\u015f\u0131 a\u015f\u0131lar halen klinik ara\u015ft\u0131rma a\u015famas\u0131ndad\u0131r ve genel kullan\u0131m i\u00e7in onaylanm\u0131\u015f bir a\u015f\u0131 hen\u00fcz bulunmamaktad\u0131r.<\/p>

    Gebelik \u00f6ncesinde ve gebeli\u011fin erken d\u00f6neminde seropozitif kad\u0131nlar<\/strong><\/p>

    CMV’ye kar\u015f\u0131 \u00f6nceden geli\u015fmi\u015f ba\u011f\u0131\u015f\u0131kl\u0131k tam koruma sa\u011flamaz. Vir\u00fcs yeniden aktive olabilir veya farkl\u0131 bir CMV su\u015fuyla yeniden enfeksiyon geli\u015febilir.<\/p>

    Mevcut bilimsel veriler, hijyen \u00f6nlemlerinin primer olmayan CMV enfeksiyonunu \u00f6nlemedeki etkinli\u011fini hen\u00fcz yeterince kan\u0131tlamam\u0131\u015f olsa da bu \u00f6nlemlere uyulmas\u0131 makul bir koruyucu yakla\u015f\u0131m olarak kabul edilmektedir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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    Gebelikte Sitomegalovir\u00fcs (CMV) Enfeksiyonunun Tan\u0131s\u0131<\/h4>

    Yeti\u015fkinlerde sitomegalovir\u00fcs (CMV) enfeksiyonu genellikle asemptomatik seyreder. Bu durum, enfeksiyonun klinik olarak tan\u0131nmas\u0131n\u0131 g\u00fc\u00e7le\u015ftirir.<\/p>

    Vir\u00fcs; kan, idrar, t\u00fck\u00fcr\u00fck, servikal salg\u0131lar ve anne s\u00fct\u00fc gibi biyolojik \u00f6rneklerde molek\u00fcler y\u00f6ntemlerle (PCR) veya g\u00fcn\u00fcm\u00fczde daha nadiren kullan\u0131lan viral k\u00fclt\u00fcr y\u00f6ntemleriyle saptanabilir.<\/p>

    Ancak bir biyolojik \u00f6rnekte CMV DNA’s\u0131n\u0131n saptanmas\u0131, tek ba\u015f\u0131na yak\u0131n zamanda ge\u00e7irilmi\u015f primer enfeksiyonu kan\u0131tlamaz.<\/p>

    Gebelik s\u0131ras\u0131nda tan\u0131sal de\u011ferlendirmenin \u00fc\u00e7 temel amac\u0131 vard\u0131r: maternal enfeksiyonun belirlenmesi, enfeksiyonun primer veya primer olmayan enfeksiyon olarak s\u0131n\u0131fland\u0131r\u0131lmas\u0131 ve fet\u00fcse olas\u0131 intrauterin bula\u015f\u0131n ara\u015ft\u0131r\u0131lmas\u0131.<\/p>

    Serolojik tan\u0131: IgM ve IgG antikorlar\u0131<\/h4>

    \u0130lk laboratuvar de\u011ferlendirmesi, CMV’ye \u00f6zg\u00fc IgM ve IgG antikorlar\u0131n\u0131n ara\u015ft\u0131r\u0131lmas\u0131na dayan\u0131r.<\/p>

    IgM antikorlar\u0131n\u0131n pozitif olmas\u0131, tek ba\u015f\u0131na yak\u0131n zamanda ge\u00e7irilmi\u015f primer enfeksiyonu kan\u0131tlamaz. IgM antikorlar\u0131 enfeksiyondan sonra aylarca pozitif kalabilir, viral reaktivasyon veya yeniden enfeksiyon s\u0131ras\u0131nda tekrar ortaya \u00e7\u0131kabilir ya da di\u011fer viral enfeksiyonlarla \u00e7apraz reaksiyon nedeniyle yalanc\u0131 pozitif sonu\u00e7 verebilir.<\/p>

    Benzer \u015fekilde, IgM antikorlar\u0131n\u0131n negatif olmas\u0131 da yak\u0131n zamanda ge\u00e7irilmi\u015f enfeksiyonu tamamen d\u0131\u015flamaz.<\/p>

    Belgelenmi\u015f IgG serokonversiyonu, daha \u00f6nce CMV IgG negatif oldu\u011fu bilinen bir kad\u0131nda IgG antikorlar\u0131n\u0131n pozitifle\u015fmesi olarak tan\u0131mlan\u0131r ve primer enfeksiyonun en g\u00fcvenilir serolojik g\u00f6stergesidir.<\/p>

    Ard\u0131\u015f\u0131k \u00f6rneklerde IgG antikor d\u00fczeylerinin artmas\u0131 tan\u0131sal de\u011ferlendirmeyi destekleyebilir. Ancak \u00f6zellikle daha \u00f6nce belgelenmi\u015f negatif bir sonu\u00e7 bulunmad\u0131\u011f\u0131nda, tek ba\u015f\u0131na primer enfeksiyon i\u00e7in g\u00fcvenilir bir kriter de\u011fildir.<\/p>

    S\u0131n\u0131rda veya birbiriyle uyumsuz sonu\u00e7larda, tercihen ayn\u0131 laboratuvar y\u00f6ntemiyle ya da uzmanla\u015fm\u0131\u015f bir referans laboratuvar\u0131nda testlerin tekrarlanmas\u0131 \u00f6nerilir.<\/p>

    CMV IgG avidite testi<\/h4>

    IgG avidite testi, CMV’ye \u00f6zg\u00fc IgG antikorlar\u0131n\u0131n viral antijenlere ba\u011flanma g\u00fcc\u00fcn\u00fc de\u011ferlendirir ve primer enfeksiyonun zaman\u0131n\u0131n tahmin edilmesine yard\u0131mc\u0131 olur.<\/p>

    • D\u00fc\u015f\u00fck avidite: kullan\u0131lan teste ba\u011fl\u0131 olarak genellikle \u00f6nceki 3\u20134 ay i\u00e7erisinde ge\u00e7irilmi\u015f primer enfeksiyonu destekler.<\/p><\/div><\/div><\/li>

    • Y\u00fcksek avidite: \u00f6zellikle gebeli\u011fin ilk trimesterinde saptand\u0131\u011f\u0131nda, yak\u0131n ge\u00e7mi\u015fte primer enfeksiyon ge\u00e7irilmi\u015f olma olas\u0131l\u0131\u011f\u0131n\u0131 azalt\u0131r.<\/p><\/div><\/div><\/li>

    • Orta d\u00fczey avidite: enfeksiyonun zaman\u0131n\u0131n g\u00fcvenilir bi\u00e7imde belirlenmesine olanak sa\u011flamaz. Klinik \u00f6yk\u00fc, gebelik haftas\u0131, \u00f6nceki serolojik sonu\u00e7lar ve gerekti\u011finde referans laboratuvar\u0131nda tekrar test ile birlikte de\u011ferlendirilmelidir.<\/p><\/div><\/div><\/li><\/ul>

      IgG avidite sonu\u00e7lar\u0131n\u0131n yorumlanmas\u0131 kullan\u0131lan teste ve gebelik haftas\u0131na ba\u011fl\u0131d\u0131r. \u00d6zellikle gebeli\u011fin ileri d\u00f6nemlerinde saptanan y\u00fcksek avidite, ilk trimesterde ge\u00e7irilmi\u015f primer enfeksiyonu d\u0131\u015flamaz.<\/p>

      D\u00fc\u015f\u00fck avidite tek ba\u015f\u0131na fetal enfeksiyonu do\u011frulamaz ve enfeksiyonun \u015fiddetini \u00f6ng\u00f6rmez.<\/p>

      \u00d6zel serolojik durumlar<\/h4>

      IgM pozitif ve IgG negatif olan gebelerde, olas\u0131 IgG serokonversiyonunu de\u011ferlendirmek amac\u0131yla yakla\u015f\u0131k iki hafta sonra serolojik testlerin tekrarlanmas\u0131 \u00f6nerilir.<\/p>

      Maternal kanda PCR ile CMV DNA ara\u015ft\u0131r\u0131lmas\u0131, se\u00e7ilmi\u015f olgularda tamamlay\u0131c\u0131 bir inceleme olarak kullan\u0131labilir; ancak serolojik de\u011ferlendirmenin yerini almaz.<\/p>

      Primer olmayan CMV enfeksiyonunun tan\u0131s\u0131 daha zordur. \u00c7\u00fcnk\u00fc IgG antikorlar\u0131 \u00f6nceden mevcuttur ve viral reaktivasyon ile yeniden enfeksiyonu g\u00fcvenilir bi\u00e7imde ay\u0131rt edebilen tek bir serolojik belirte\u00e7 bulunmamaktad\u0131r.<\/p>

      Ayr\u0131ca amniyotik s\u0131v\u0131da CMV DNA’s\u0131n\u0131n saptanmas\u0131 fetal enfeksiyonu do\u011frular, ancak maternal enfeksiyonun primer mi yoksa primer olmayan bir enfeksiyon mu oldu\u011funu tek ba\u015f\u0131na belirleyemez.<\/p>

      Prenatal serolojik tarama<\/h4>

      Gebelikte t\u00fcm kad\u0131nlara rutin CMV serolojik taramas\u0131 uygulanmas\u0131 konusunda uluslararas\u0131 \u00f6neriler farkl\u0131l\u0131k g\u00f6stermektedir. Bir\u00e7ok meslek kurulu\u015fu, evrensel taramay\u0131 rutin olarak \u00f6nermemektedir.<\/p>

      Maternal enfeksiyondan klinik olarak \u015f\u00fcphelenildi\u011finde, olas\u0131 CMV maruziyeti bulundu\u011funda, \u00f6nceki serolojik sonu\u00e7lar \u015f\u00fcpheli oldu\u011funda veya fetal ultrasonografide konjenital enfeksiyonu d\u00fc\u015f\u00fcnd\u00fcren bulgular saptand\u0131\u011f\u0131nda hedefe y\u00f6nelik inceleme yap\u0131lmas\u0131 uygundur.<\/p>

      Seronegatif gebelerde tekrarlanan serolojik taramalar belirli prenatal takip protokollerine dahil edilebilir. Bununla birlikte taraman\u0131n s\u0131kl\u0131\u011f\u0131 ve s\u00fcresi konusunda evrensel olarak kabul edilmi\u015f tek bir yakla\u015f\u0131m bulunmamaktad\u0131r.<\/p>

      Fetal enfeksiyonun prenatal tan\u0131s\u0131<\/h4>

      Do\u011frulanm\u0131\u015f veya kuvvetle \u015f\u00fcphelenilen primer maternal CMV enfeksiyonu durumunda ya da \u015f\u00fcpheli fetal ultrasonografi bulgular\u0131 varl\u0131\u011f\u0131nda invaziv prenatal tan\u0131sal inceleme gerekebilir.<\/p>

      Konjenital CMV enfeksiyonunu d\u00fc\u015f\u00fcnd\u00fcren ultrasonografik bulgular aras\u0131nda ventrik\u00fclomegali, mikrosefali, intrakraniyal kalsifikasyonlar, beyin geli\u015fim anomalileri, hiperekojen ba\u011f\u0131rsak, hepatosplenomegali, karaci\u011fer kalsifikasyonlar\u0131, asit, fetal hidrops ve fetal b\u00fcy\u00fcme k\u0131s\u0131tl\u0131l\u0131\u011f\u0131 yer almaktad\u0131r.<\/p>

      Amniyosentez ile elde edilen amniyotik s\u0131v\u0131da PCR y\u00f6ntemiyle CMV DNA’s\u0131n\u0131n ara\u015ft\u0131r\u0131lmas\u0131, fetal CMV enfeksiyonunun prenatal tan\u0131s\u0131nda temel y\u00f6ntemdir.<\/p>

      Yalanc\u0131 negatif sonu\u00e7 riskini azaltmak amac\u0131yla amniyosentez genellikle gebeli\u011fin 20\u201321. haftas\u0131ndan sonra ve tahmini maternal enfeksiyondan en az 6\u20138 hafta ge\u00e7tikten sonra uygulan\u0131r. Kesin zamanlama kullan\u0131lan klinik protokole ba\u011fl\u0131d\u0131r.<\/p>

      Amniyotik s\u0131v\u0131da CMV PCR testinin pozitif olmas\u0131 fetal enfeksiyonu do\u011frular; ancak hastal\u0131\u011f\u0131n \u015fiddetini veya uzun d\u00f6nem n\u00f6rogeli\u015fimsel komplikasyon riskini tek ba\u015f\u0131na \u00f6ng\u00f6remez.<\/p>

      Prognozun de\u011ferlendirilmesi i\u00e7in ayr\u0131nt\u0131l\u0131 uzman ultrasonografisi, gerekli durumlarda fetal manyetik rezonans g\u00f6r\u00fcnt\u00fcleme ve d\u00fczenli takip gereklidir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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      Konjenital Sitomegalovir\u00fcs (CMV) Enfeksiyonunun Sekonder \u00d6nlenmesi<\/h4>

      Sekonder korunman\u0131n amac\u0131, sitomegalovir\u00fcs\u00fcn (CMV) anneden fet\u00fcse intrauterin ge\u00e7i\u015f riskini azaltmak ve b\u00f6ylece konjenital enfeksiyonu \u00f6nlemektir.<\/p>

      Gebelik \u00f6ncesi d\u00f6nemde, d\u00f6llenme \u00e7evresindeki d\u00f6nemde veya gebeli\u011fin ilk trimesterinde do\u011frulanm\u0131\u015f primer CMV enfeksiyonu bulunan kad\u0131nlarda y\u00fcksek doz valasiklovir (valaciclovir), g\u00fcnl\u00fck 8 g (g\u00fcnde d\u00f6rt kez 2 g) uygulanmas\u0131n\u0131n, vir\u00fcs\u00fcn plasenta yoluyla fet\u00fcse ge\u00e7i\u015fini \u00f6nemli \u00f6l\u00e7\u00fcde azaltt\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir.<\/p>

      Randomize bir klinik \u00e7al\u0131\u015fmada valasiklovir tedavisi, plaseboya k\u0131yasla fetal CMV enfeksiyonu riskini g\u00f6receli olarak yakla\u015f\u0131k %71 azaltm\u0131\u015ft\u0131r. Bu sonu\u00e7 esas olarak erken d\u00f6nemde geli\u015fen primer maternal enfeksiyon i\u00e7in ge\u00e7erlidir ve gebelikteki t\u00fcm CMV enfeksiyonlar\u0131na genellenmemelidir.<\/p>

      Tan\u0131dan sonra tedaviye erken ba\u015flanmas\u0131, \u00f6zellikle primer maternal enfeksiyonun ilk trimesterde meydana geldi\u011fi durumlarda, tedavinin etkinli\u011fi a\u00e7\u0131s\u0131ndan \u00f6nemli kabul edilmektedir. Gebeli\u011fin daha ileri d\u00f6nemlerinde ortaya \u00e7\u0131kan enfeksiyonlarda tedavinin etkinli\u011fi ayn\u0131 d\u00fczeyde kan\u0131tlanmam\u0131\u015ft\u0131r.<\/p>

      G\u00fcvenlilik ve yan etkiler<\/h4>

      G\u00fcnl\u00fck 8 g valasiklovir uygulanmas\u0131 dikkatli t\u0131bbi takip gerektirir. \u00c7\u00fcnk\u00fc bu doz, di\u011fer herpesvir\u00fcs enfeksiyonlar\u0131nda kullan\u0131lan standart dozlardan belirgin \u015fekilde y\u00fcksektir.<\/p>

      Olas\u0131 yan etkiler aras\u0131nda bulant\u0131, kusma ve akut b\u00f6brek hasar\u0131 dahil olmak \u00fczere b\u00f6brek fonksiyon bozukluklar\u0131 bulunmaktad\u0131r.<\/p>

      Orijinal metinde gastrointestinal yan etkilerin hastalar\u0131n %21’inde, hafif ila orta derecede akut b\u00f6brek hasar\u0131n\u0131n ise %2’sinde g\u00f6r\u00fcld\u00fc\u011f\u00fc ve tedavi kesildikten sonra d\u00fczeldi\u011fi belirtilmektedir. Bu oranlar\u0131n genel risk tahminleri olarak kullan\u0131lmadan \u00f6nce ilgili \u00f6zg\u00fcn \u00e7al\u0131\u015fma ile do\u011frulanmas\u0131 gerekmektedir.<\/p>

      Tedavi s\u0131ras\u0131nda yeterli s\u0131v\u0131 al\u0131m\u0131n\u0131n sa\u011flanmas\u0131, b\u00f6brek fonksiyonlar\u0131n\u0131n d\u00fczenli olarak izlenmesi ve gerekli durumlarda doz ayarlamas\u0131 yap\u0131lmas\u0131 \u00f6nemlidir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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      Fetal CMV Enfeksiyonunun Prenatal Tan\u0131s\u0131<\/h4>

      Fetal sitomegalovir\u00fcs (CMV) enfeksiyonunun prenatal tan\u0131s\u0131, amniyosentez ile elde edilen amniyotik s\u0131v\u0131da polimeraz zincir reaksiyonu (PCR) y\u00f6ntemiyle viral DNA’n\u0131n saptanmas\u0131na dayan\u0131r.<\/p>

      Amniyosentez genellikle gebeli\u011fin 20\u201321. haftas\u0131ndan sonra ve tahmini maternal enfeksiyondan en az 6\u20138 hafta ge\u00e7tikten sonra ger\u00e7ekle\u015ftirilir. Bu zamanlama, yalanc\u0131 negatif sonu\u00e7 riskini azaltmay\u0131 ama\u00e7lar.<\/p>

      Yeni veriler, se\u00e7ilmi\u015f olgularda ve uzmanla\u015fm\u0131\u015f merkezlerde, primer maternal enfeksiyondan en az sekiz hafta ge\u00e7mi\u015f olmas\u0131 ko\u015fuluyla, incelemenin gebeli\u011fin 17. haftas\u0131ndan itibaren yap\u0131labilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir. Ancak bu yakla\u015f\u0131m, uygun dan\u0131\u015fmanl\u0131k ve y\u00f6ntemin s\u0131n\u0131rl\u0131l\u0131klar\u0131n\u0131n de\u011ferlendirilmesini gerektirir.<\/p>

      Amniyotik s\u0131v\u0131da PCR testinin pozitif olmas\u0131 intrauterin enfeksiyonu do\u011frular; ancak tek ba\u015f\u0131na fetal viremi varl\u0131\u011f\u0131n\u0131 veya hastal\u0131\u011f\u0131n \u015fiddetini g\u00f6stermez.<\/p>

      Amniyotik s\u0131v\u0131da negatif PCR sonucu<\/h4>

      Amniyosentezin uygun zamanda yap\u0131lm\u0131\u015f olmas\u0131 ko\u015fuluyla, negatif PCR sonucu fetal enfeksiyon olas\u0131l\u0131\u011f\u0131n\u0131 \u00f6nemli \u00f6l\u00e7\u00fcde azalt\u0131r.<\/p>

      Bununla birlikte, daha sonra ger\u00e7ekle\u015febilecek transplasental bula\u015f\u0131 veya \u00f6zellikle maternal enfeksiyondan k\u0131sa s\u00fcre sonra yap\u0131lan testlerde yalanc\u0131 negatif sonucu tamamen d\u0131\u015flamaz.<\/p>

      Negatif PCR sonucundan sonra koruyucu valasiklovir tedavisinin sonland\u0131r\u0131lmas\u0131 karar\u0131, tedavi protokol\u00fc, maternal enfeksiyonun zaman\u0131 ve ultrasonografi bulgular\u0131 dikkate al\u0131narak bireyselle\u015ftirilmelidir.<\/p>

      Fetal enfeksiyon do\u011fruland\u0131ktan sonra takip<\/h4>

      Amniyotik s\u0131v\u0131da PCR pozitifli\u011fi ile fetal CMV enfeksiyonu do\u011fruland\u0131\u011f\u0131nda, uzmanla\u015fm\u0131\u015f bir fetal t\u0131p merkezinde d\u00fczenli takip gereklidir.<\/p>

      Takip kapsam\u0131nda, \u00f6zellikle fetal beyin anatomisi, fetal b\u00fcy\u00fcme ve beyin d\u0131\u015f\u0131 anomalilerin de\u011ferlendirilmesi amac\u0131yla 3\u20134 haftada bir ayr\u0131nt\u0131l\u0131 ultrasonografi yap\u0131l\u0131r.<\/p>

      Fetal manyetik rezonans g\u00f6r\u00fcnt\u00fcleme (MRI), genellikle gebeli\u011fin 28\u201332. haftalar\u0131 aras\u0131nda, \u00f6zellikle \u015f\u00fcpheli veya belirsiz ultrasonografi bulgular\u0131 bulundu\u011funda fetal beynin daha ayr\u0131nt\u0131l\u0131 de\u011ferlendirilmesini sa\u011flar.<\/p>

      Ek prognostik bilgi sa\u011flayabilece\u011fi d\u00fc\u015f\u00fcn\u00fclen se\u00e7ilmi\u015f olgularda MRI incelemesi tekrarlanabilir.<\/p>

      Ayr\u0131nt\u0131l\u0131 ultrasonografi ve fetal MRI incelemelerinde \u00f6nemli bir anormallik saptanmamas\u0131, olduk\u00e7a olumlu bir prognostik bulgudur. Bununla birlikte, sens\u00f6rin\u00f6ral i\u015fitme kayb\u0131n\u0131 veya daha sonra ortaya \u00e7\u0131kabilecek di\u011fer komplikasyonlar\u0131 tamamen d\u0131\u015flamaz.<\/p>

      Fetal trombositopeninin ara\u015ft\u0131r\u0131lmas\u0131 amac\u0131yla fetal kan \u00f6rneklemesi, baz\u0131 uzmanla\u015fm\u0131\u015f merkezlerde ek bir prognostik y\u00f6ntem olarak kullan\u0131lm\u0131\u015ft\u0131r. Ancak invaziv i\u015flemin ta\u015f\u0131d\u0131\u011f\u0131 riskler nedeniyle rutin olarak \u00f6nerilmemektedir.<\/p>

      Hastal\u0131k \u015fiddetinin prenatal de\u011ferlendirilmesi<\/h4>

      G\u00f6r\u00fcnt\u00fcleme ve mevcut oldu\u011funda laboratuvar bulgular\u0131na dayanarak fetal CMV enfeksiyonu \u00fc\u00e7 geni\u015f prognostik kategoriye ayr\u0131labilir.<\/p>

      1. Belirgin anormallik saptanmayan fetal enfeksiyon<\/p>

      Amniyotik s\u0131v\u0131da PCR pozitiftir, ancak ayr\u0131nt\u0131l\u0131 ultrasonografi ve fetal MRI incelemelerinde \u00f6nemli bir anormallik saptanmaz.<\/p>

      Genel prognoz olumludur. Bununla birlikte, tek veya \u00e7ift tarafl\u0131 sens\u00f6rin\u00f6ral i\u015fitme kayb\u0131 geli\u015febilir. \u0130\u015fitme kayb\u0131 do\u011fumda mevcut olabilece\u011fi gibi daha sonra da ortaya \u00e7\u0131kabilir.<\/p>

      2. Hafif-orta derecede semptomatik fetal enfeksiyon<\/p>

      Hiperekojen ba\u011f\u0131rsak, karaci\u011fer kalsifikasyonlar\u0131 veya hafif ventrik\u00fclomegali gibi s\u0131n\u0131rl\u0131 anomaliler g\u00f6r\u00fclebilir.<\/p>

      Prognoz, bulgular\u0131n t\u00fcr\u00fcne, birlikteli\u011fine ve zaman i\u00e7indeki ilerlemesine ba\u011fl\u0131d\u0131r. Bireyselle\u015ftirilmi\u015f dan\u0131\u015fmanl\u0131k ve d\u00fczenli takip gereklidir.<\/p>

      3. A\u011f\u0131r semptomatik fetal enfeksiyon<\/p>

      Mikrosefali, a\u011f\u0131r ventrik\u00fclomegali, serebral korteks geli\u015fim anomalileri, yayg\u0131n beyin lezyonlar\u0131 veya fetal hidrops gibi ciddi serebral ya da sistemik anomalilerle karakterizedir.<\/p>

      Bu bulgular, olumsuz n\u00f6rogeli\u015fimsel sonu\u00e7 riskinin artmas\u0131yla ili\u015fkilidir.<\/p>

      Prognoz, mevcut tedavi se\u00e7enekleri, gebeli\u011fin devam\u0131 ve yasal olarak izin verilen durumlarda gebeli\u011fin sonland\u0131r\u0131lmas\u0131 se\u00e7ene\u011fi hakk\u0131nda multidisipliner dan\u0131\u015fmanl\u0131k sa\u011flanmal\u0131d\u0131r.<\/p>

      A\u011f\u0131r fetal CMV enfeksiyonu tan\u0131s\u0131, gebeli\u011fin mutlaka sonland\u0131r\u0131lmas\u0131 gerekti\u011fi anlam\u0131na gelmez.<\/p>

      Konjenital CMV Enfeksiyonunun (cCMV) Klinik, Laboratuvar ve G\u00f6r\u00fcnt\u00fcleme Bulgular\u0131<\/h4>

      A\u015fa\u011f\u0131daki bulgular\u0131n \u00e7o\u011fu do\u011fum sonras\u0131nda de\u011ferlendirilir. Ancak baz\u0131lar\u0131 prenatal d\u00f6nemde de saptanabilir.<\/p>

      Kategori<\/p><\/th>

      Klinik ve tan\u0131sal bulgular<\/p><\/th><\/tr>

      Klinik belirti ve bulgular<\/p><\/td>

      \u0130ntrauterin b\u00fcy\u00fcme k\u0131s\u0131tl\u0131l\u0131\u011f\u0131 veya gebelik haftas\u0131na g\u00f6re k\u00fc\u00e7\u00fck olma, mikrosefali, pete\u015fi veya purpura, blueberry muffin d\u00f6k\u00fcnt\u00fcs\u00fc, sar\u0131l\u0131k, hepatomegali, splenomegali, letarji, hipotoni, n\u00f6betler ve beslenme g\u00fc\u00e7l\u00fckleri<\/p><\/td><\/tr>

      Laboratuvar bulgular\u0131<\/p><\/td>

      Anemi, trombositopeni (\u00f6rne\u011fin 100.000\/\u03bcL alt\u0131nda), l\u00f6kopeni veya n\u00f6tropeni, karaci\u011fer transaminazlar\u0131nda y\u00fckselme ve konjuge hiperbilirubinemi<\/p><\/td><\/tr>

      Beyin omurilik s\u0131v\u0131s\u0131 (BOS)<\/p><\/td>

      Anormal biyokimyasal veya h\u00fccresel parametreler ve olas\u0131 CMV DNA pozitifli\u011fi<\/p><\/td><\/tr>

      \u0130nflamatuvar veya destr\u00fcktif beyin lezyonlar\u0131<\/p><\/td>

      Lentik\u00fclostriat vask\u00fclopati, germinolitik ps\u00f6dokistler, lateral ventrik\u00fcllerin oksipital boynuzlar\u0131nda septasyonlar, ventrik\u00fclomegali, periventrik\u00fcler kalsifikasyonlar ve beyaz cevher anomalileri<\/p><\/td><\/tr>

      Beyin geli\u015fim anomalileri<\/p><\/td>

      Polimikrogiri, anormal kortikal sulkasyon ve serebellar hipoplazi<\/p><\/td><\/tr>

      Odyolojik bulgular<\/p><\/td>

      Do\u011fumdan sonra ortaya \u00e7\u0131kabilen veya ilerleyebilen tek ya da \u00e7ift tarafl\u0131 sens\u00f6rin\u00f6ral i\u015fitme kayb\u0131<\/p><\/td><\/tr>

      Oftalmolojik bulgular<\/p><\/td>

      Koryoretinit veya koryoretinal skarla\u015fma<\/p><\/td><\/tr><\/tbody><\/table><\/div>

      \u00a0<\/p>

      \u00a0<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
      \n\t\t\t\t\t\t\t\t\t

      Yenido\u011fanda Konjenital Sitomegalovir\u00fcs (CMV) Enfeksiyonunun Tan\u0131s\u0131<\/h4>

      Konjenital sitomegalovir\u00fcs (cCMV) enfeksiyonunu do\u011fum sonras\u0131 edinilmi\u015f CMV enfeksiyonundan ay\u0131rt edebilmek i\u00e7in vir\u00fcs\u00fcn ya\u015fam\u0131n ilk 21 g\u00fcn\u00fc i\u00e7erisinde saptanmas\u0131 gerekmektedir.<\/p>

      Tan\u0131, yenido\u011fan\u0131n idrar veya t\u00fck\u00fcr\u00fck \u00f6rneklerinde polimeraz zincir reaksiyonu (PCR) y\u00f6ntemiyle CMV DNA’s\u0131n\u0131n molek\u00fcler olarak g\u00f6sterilmesiyle konur.<\/p>

      T\u00fck\u00fcr\u00fck PCR testi, \u00f6rnek al\u0131m\u0131n\u0131n kolay, noninvaziv ve yenido\u011fan taramas\u0131na uygun olmas\u0131 nedeniyle s\u0131kl\u0131kla ilk tarama y\u00f6ntemi olarak kullan\u0131lmaktad\u0131r.<\/p>

      Ancak t\u00fck\u00fcr\u00fck PCR testinde elde edilen her pozitif sonu\u00e7, idrar PCR testi ile do\u011frulanmal\u0131d\u0131r. Bunun ba\u015fl\u0131ca nedeni, \u00f6zellikle anne s\u00fct\u00fcnde bulunan CMV nedeniyle t\u00fck\u00fcr\u00fck \u00f6rne\u011finin kontamine olabilmesidir.<\/p>

      Yalanc\u0131 pozitif sonu\u00e7 riskini azaltmak amac\u0131yla t\u00fck\u00fcr\u00fck \u00f6rneklerinin tercihen emzirmeden en az 1\u20132 saat sonra al\u0131nmas\u0131 \u00f6nerilmektedir.<\/p>

      Ya\u015fam\u0131n ilk 21 g\u00fcn\u00fcnden sonra CMV saptanmas\u0131, enfeksiyonun konjenital mi yoksa do\u011fum sonras\u0131 edinilmi\u015f mi oldu\u011funu her zaman g\u00fcvenilir bi\u00e7imde ay\u0131rt etmeye olanak sa\u011flamaz.<\/p>

      Bu durumlarda, mevcutsa yenido\u011fan taramas\u0131 s\u0131ras\u0131nda al\u0131nm\u0131\u015f ve saklanm\u0131\u015f kurutulmu\u015f kan damlas\u0131 \u00f6rne\u011finde (dried blood spot) geriye d\u00f6n\u00fck CMV PCR incelemesi d\u00fc\u015f\u00fcn\u00fclebilir.<\/p>

      Ancak bu y\u00f6ntemin duyarl\u0131l\u0131\u011f\u0131 s\u0131n\u0131rl\u0131d\u0131r ve negatif sonu\u00e7 konjenital enfeksiyonu d\u0131\u015flamaz.<\/p>

      Konjenital CMV enfeksiyonu do\u011fruland\u0131ktan sonra ayr\u0131nt\u0131l\u0131 neonatal de\u011ferlendirme yap\u0131lmal\u0131d\u0131r. Bu de\u011ferlendirme klinik muayeneyi, laboratuvar incelemelerini, odyolojik de\u011ferlendirmeyi ve gerekli durumlarda n\u00f6rog\u00f6r\u00fcnt\u00fcleme ile oftalmolojik muayeneyi i\u00e7ermektedir.<\/p>

      Erken tan\u0131 b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r, \u00e7\u00fcnk\u00fc antiviral tedaviden yarar g\u00f6rebilecek yenido\u011fanlar\u0131n belirlenmesini ve i\u015fitme ile n\u00f6rogeli\u015fimsel durumlar\u0131n\u0131n d\u00fczenli olarak izlenmesini sa\u011flar.<\/p>

      \u00a0<\/p>

      \u0392\u03b9\u03b2\u03bb\u03b9\u03bf\u03b3\u03c1\u03b1\u03c6\u03af\u03b1:<\/strong><\/p>

      • Cytomegalovirus, Parvovirus B19, Varicella Zoster, and Toxoplasmosis in Pregnancy PRACTICE BULLETIN Number 151, JuNe 2015<\/li>
      • Diagnosis and antenatal management of congenital cytomegalovirus infection Society for Maternal-Fetal Medicine(SMFM) Consult Series 39<\/li>
      • Guillaume Benoista, b Marianne Leruez-Villec Jean Fran\u00e7ois Magnyd Fran\u00e7ois Jacquemarde Laurent J. Salomona Yves Villea Management of Pregnancies with Confirmed Cytomegalovirus Fetal Infection Fetal Diagn Ther 2013;33:203\u2013214<\/li>
      • Consensus recommendation for prenatal, neonatal and postnatal management of congenital cytomegalovirus infection from the European congenital infection initiative (ECCI). <\/span>Leruez-Ville M, Chatzakis C, Lilleri D, Blazquez-Gamero D, Alarcon A, Bourgon N, Foulon I, Fourgeaud J, Gonce A, Jones CE, Klapper P, Krom A, Lazzarotto T, Lyall H, Paixao P, Papaevangelou V, Puchhammer E, Sourvinos G, Vallely P, Ville Y, Vossen A.<\/span>Lancet Reg Health Eur. 2024 Apr 1;40:100892. <\/span><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

        Primer enfeksiyondan sonra vir\u00fcs, konak h\u00fccrelerde latent (gizli) durumda kal\u0131r ve daha sonra yeniden aktive olabilir. Ayr\u0131ca farkl\u0131 bir viral su\u015fla yeniden enfeksiyon geli\u015febilir (primer olmayan [\u2026]<\/span><\/p>\n","protected":false},"author":3,"featured_media":-1,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[125,79],"tags":[],"class_list":["post-2528","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-konjenital-enfeksiyonlar","category-obstetrik"],"yoast_head":"\nGebelikte Sitomegalovir\u00fcs (CMV) Enfeksiyonu - \u0391\u03bb\u03ad\u03be\u03b1\u03bd\u03b4\u03c1\u03bf\u03c2 \u039c\u03ac\u03b9\u03bd\u03b1\u03c2 MD, PhD<\/title>\n<meta name=\"description\" content=\"Gebelerde primer CMV enfeksiyonu g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 yakla\u015f\u0131k %1\u20132, transplasental yolla fet\u00fcse bula\u015fma oran\u0131 ise 'dir. Primer olmayan enfeksiyonun g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 yakla\u015f\u0131k ,5 olup fet\u00fcse bula\u015fma oran\u0131 %3,5'in alt\u0131ndad\u0131r.CMV, yenido\u011fanlarda en s\u0131k g\u00f6r\u00fclen konjenital enfeksiyondur ve bildirilen s\u0131kl\u0131\u011f\u0131 %0,2\u20132,2 aras\u0131nda de\u011fi\u015fmektedir.\" \/>\n<meta name=\"robots\" content=\"noindex, follow\" \/>\n<meta property=\"og:locale\" content=\"tr_TR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Gebelikte Sitomegalovir\u00fcs (CMV) Enfeksiyonu - \u0391\u03bb\u03ad\u03be\u03b1\u03bd\u03b4\u03c1\u03bf\u03c2 \u039c\u03ac\u03b9\u03bd\u03b1\u03c2 MD, PhD\" \/>\n<meta property=\"og:description\" content=\"Gebelerde primer CMV enfeksiyonu g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 yakla\u015f\u0131k %1\u20132, transplasental yolla fet\u00fcse bula\u015fma oran\u0131 ise 'dir. 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