TORCH infections during pregnancy are intrauterine infections. Congenital infections have attracted a lot of medical attention, since infant mortality is largely due to them (up to 25% of deaths).
According to statistics, almost 80% of congenital malformations are related to the problem of transplacental infection of the fetus. Moreover, about 30% of such children die before the age of one year.
Intrauterine infections have been studied for a long time, but only in 1971 WHO brought together the most common ones and called this list TORCH syndrome.
Attention. Most often, the source of infection for the fetus is the mother. However, in recent years it has been noted that prenatal diagnosis (invasive methods), as well as some treatment methods (umbilical cord puncture, amniocentesis) can contribute to iatrogenic intrauterine infection of the fetus.
TORCH infection - what is it?
TORCH infections is a medical abbreviation consisting of the first letters of infectious pathologies that can be transmitted to the fetus from a woman carrying a child (a group of perinatal infections).
According to official statistics from the World Health Organization (WHO), TORCH infections are the cause of about 5% of all congenital developmental pathologies in newborns worldwide. Although according to some sources this figure can reach 10-15%%.
The list of main TORCH infections (TORCH or TORCHS infections) includes:
- T - toxoplasma infections;
- O - other infections, including mycoplasma, syphilis, gonorrhea, chlamydial infections, hepatitis, streptococcal infections, candidal infections, as well as other diseases of viral or bacterial etiology;
- R - rubella;
- C - cytomegalovirus infection;
- H - other herpes infections.
Is it necessary to get tested for TORCH infection during pregnancy?
A feature of TORCH infections is that most of them (chickenpox, rubella) are most often easily tolerated by both adults and children. The disease is usually mild and rarely accompanied by complications.
Attention. However, TORCH infections during pregnancy, even if they are mild for the pregnant woman herself, pose the highest degree of threat to the unborn child.
These infections can lead to:
- intrauterine death of a child,
- development of intrauterine infectious pathologies and fetal abnormalities.
The risk to the fetus depends on the type of TORCH, the duration of infection of the pregnant woman, and also on whether timely treatment was prescribed (for most infections, if therapy is started on time, the risk of damage to the fetus is minimized).
For reference. In this regard, analysis for TORCH infection is the most important type of research conducted during pregnancy.
Ideally, the study should be carried out at the stage of pregnancy planning. This study is of particular importance for women who do not know whether they had chickenpox and rubella in childhood or not.
In cases where a woman planning a pregnancy does not have immunoglobulins to the causative agent of rubella or chickenpox, she may be recommended vaccination against these diseases (it is recommended to use barrier methods of contraception for at least three months after vaccination).
Prevention of infection
If a woman has not previously suffered from TORCH infections, then the doctor should instruct her on preventive measures to minimize the risk of infection.
For example, to protect yourself from infection with toxoplasmosis, you must:
1) exclude contact with a pet by giving the cat to relatives during pregnancy; if this is not possible, then when cleaning the cat's litter box you should wear rubber gloves or assign another family member to clean up after your pet;
2) observe the rules of personal hygiene (wash your hands after each stay in public places, do not lick your fingers or bite your nails); Family members should also wash their hands after each contact with an animal or its feces, as well as after handling raw meat when preparing food; children must wash their hands after playing on the playground or in the sandbox;
3) monitor the cleanliness of food (carefully wash vegetables, fruits and berries);
4) do not allow eating raw (undercooked) meat; tasting raw minced meat “for salt” is also dangerous;
5) ensure that the pet does not walk on the table;
6) do not kiss the animal.
To protect the fetus from exposure to rubella, you must:
1) at least six months before planning to conceive a child, get vaccinated against rubella;
2) avoid crowded places if pregnancy has already occurred, because pregnant women cannot be vaccinated;
3) when in the company of people (for example, when working at an office or getting there by minibus), wear a cotton-gauze bandage, since rubella is transmitted by airborne droplets (it must be changed every two hours); This is especially true for kindergarten and children's hospital workers, because rubella is a common childhood infection.
Cytomegalovirus is an insidious infection. It is transmitted sexually (through semen and vaginal secretions), food (with mother's milk), and airborne droplets (through saliva). The virus can also be excreted in urine and feces. The virus is also transmitted through blood.
Therefore, there are no preventive measures as such. If a woman has not had CMV before pregnancy, then the main thing is to maintain personal hygiene and have sexual relations with a regular partner (using a condom).
As researchers have noted, infection occurs from prolonged contact with a sick person, so it is more likely to catch the infection from a relative or friend than from a fleeting meeting in a supermarket with a carrier of the virus.
Measures to prevent herpes include using a condom during sexual intercourse with an infected person.
In addition, you must have individual hygiene items (toothbrush, razor, towel) that only you will use.
It is also not recommended to kiss when meeting possible carriers of the disease (friends and relatives).
What does a blood test show for TORCH infection?
An analysis for TORCH infection during pregnancy is carried out to determine the levels of Ig class M and G for the main types of infections transmitted in utero.
A high level of Ig class M indicates acute infection or recent infection.
When Ig class G is detected, we are talking about a previous infection (in the case of chickenpox and rubella - about the presence of immunity to these infections). With a significant increase in Ig G, they speak of a recurrence of a previous infection.
During pregnancy planning, it is more important to identify class G immunoglobulins (determination of immunity), since a large TORCH for the fetus is most dangerous precisely when the mother is initially infected (with relapses of a previous infection, the risk of damage to the fetus is lower).
Interpretation of the results of serological studies
Pregnancy is an important and responsible moment for every family. Already at the planning stage, future parents need to undergo examination to exclude infections that affect the proper development of the fetus.
An important test during pregnancy and when planning it is an analysis for TORCH infection. For pregnant women, the study is mandatory.
When interpreting test results for TORCH infections, five types of intrauterine and sexually transmitted infections are simultaneously determined.
The abbreviation TORCH is not a separate disease, but a complex of intrauterine infections in the fairer sex. During pregnancy, infection threatens mother and fetus.
Infections that develop in the first trimester (up to 12 weeks), when the internal organs and systems of the child are formed, are dangerous.
TORCH viruses in children born to an infected woman can manifest themselves immediately after birth in the form of deformities or subsequently manifest as disturbances in psycho-emotional and physical development.
The abbreviation TORCH is deciphered separately for each specific letter that corresponds to the infectious agent. Each of the infections is dangerous for expectant mothers and the fetus. The TORCH decryption looks like this:
- T – toxoplasma gondii. Toxoplasma is a causative agent of parasitic infections that live inside cells. Carriers of infection are domestic and other animals that leave traces in houses.
- O – group of infectious agents: sexually transmitted diseases (syphilis, gonorrhea); viral infections (hepatitis, immunodeficiency virus); other infectious reactions to microorganisms (chlamydia, mycoplasma, ureaplasma).
- R – rubella (rubella). The causative agent is a virus transmitted through airborne contact. If rubella was contracted in childhood, the person develops a strong immunity to the infection. Women who have not had rubella as children and have not been vaccinated before are advised to terminate their pregnancy.
- C – CMV (CMV). Cytomegalovirus infection is sometimes present in the body for a long period and does not manifest itself. If the infection occurs after conception, then the question of medical termination of pregnancy arises.
- H – HSV (herpes simplex virus) is a herpes viral infection of two types. When infected with genital herpes, there is a high risk of infection of the fetus during intrauterine development and during passage through the birth canal.
Infectious pathogens, united in a common complex called TORCH, are capable of causing infection of the fetus during embryonic development, which is dangerous for the child.
Infections pose a serious threat to health and the expectant mother.
It is recommended to take a blood test for TORCH infection already at the stage of pregnancy planning, which will eliminate a large number of undesirable consequences for the mother and the unborn child.
Among the laboratory methods for diagnosing TORCH infections, there are several types of studies that determine the production of antibodies in the blood to viruses.
An accessible and common method is ELISA – enzyme-linked immunosorbent assay.
PCR is used - a polysize chain reaction, which is used to determine not antibodies, but the DNA and RNA of the virus in the test material (urine, blood, scrapings from the mucous membranes of the genitourinary system).
Conducting ELISA and PCR studies simultaneously increases efficiency and makes it possible to diagnose the presence of the virus and its type.
Additionally, or as an independent analysis, PIF is carried out - a method of direct immunofluorescence, which is highly informative. The diagnostic value increases when carried out in combination with PCR.
Bacterial culture for microflora and cytological examination are direct ways to determine TORCH infections.
Cytological diagnosis does not carry high reliability, since it determines indirect signs of infection (gonorrhea, chlamydia, herpes); other methods are required for confirmation.
Testing for TORCH infections is easy. When an expectant mother registers with a gynecologist, the doctor issues a referral for examination without fail.
If conception is planned, then you need to contact a gynecologist for recommendations and a referral for analysis, or contact the laboratory yourself. When performing ELISA, venous blood is collected. You need to take the test on an empty stomach in the morning.
After dinner, at least 8 hours should pass. Antibiotic therapy must be stopped several weeks before the test.
In the case of a study using the PCR method, when the material being tested is not blood, but other media (urine, genital secretions), then the requirements for preparation are different.
To obtain correct test results, a woman must avoid sexual intercourse for 24 hours before collecting the material. Do not use intimate hygiene products. 3-4 hours should pass after the last urination.
When planning a pregnancy, you need to take the test after the end of your period. More detailed recommendations are given by the attending gynecologist.
ELISA is the most common way to diagnose TORCH infection. The meaning of many of the indicators indicated in the analysis form is unclear to expectant mothers. Let's take a closer look at what each of the values means and what the result indicates.
For example, Ig are antibodies (immunoglobulins) produced in response to the introduction of a foreign antigen at a certain stage of the disease. Regarding the stage of pathology at which antibodies are produced, they are divided into classes: A, E, M, G, D and others.
When diagnosing TORCH infections, immunoglobulins M and G are considered.
Antibodies of class M are produced in the initial stages of infection (exacerbation).
The presence of immunoglobulins G is characteristic of the later stages, as well as the remission stage, or means that the body has developed immunity.
When analyzing these types of pathogens, the antibody titer and avidity index are also indicated. For cytomegalovirus, toxoplasmosis, herpes and rubella, the study results are expressed in the following values:
- negative IgM and IgG means that there is no immune infection. When carrying a fetus, it is necessary to observe disease prevention measures;
- IgM – positive, IgG – negative, this combination is a sign that there has been a recent infection;
- IgM – negative, IgG – positive, this result means the following: toxoplasmosis – more than one year has passed since infection; rubella – the presence of immunity and no danger to the child, if the IgG level is more than 10 IU/ml; if the IgG level is less than 10 IU/ml, vaccination is necessary when planning conception; herpes, CMV – remission stage, monitoring of antibody levels is required;
- IgM – positive, IgG – positive. In case of toxoplasmosis and rubella, this combination means the manifestation of an acute infection; for reliability, it is necessary to repeat the study two weeks later, conduct an analysis for the avidity of antibodies G and undergo a consultation with an infectious disease specialist. With herpes and CMV, the result is a sign of re-infection or indicates an acute form of the disease. It is necessary to repeat the analysis two weeks later and a test for immunoglobulin G avidity is indicated.
The test results must be interpreted by the supervising physician. If necessary, additional studies will be prescribed.
Correctly deciphering the results of the study can only be done with certain medical knowledge; you do not need to do this yourself.
The doctor determines the tactics of further actions based on the patient’s condition, medical history and research results.
For the fetus during intrauterine development, primary infection of the mother is considered the most dangerous. The risk of complications increases if the expectant mother becomes infected in the first trimester.
If a woman is tested for antibodies when planning to conceive, and they are detected, then she can conceive a child without fear. The immunity formed in the body will provide protection to her and the child.
If there are no antibodies, you need to take measures to protect yourself and the unborn baby.
When infected in the later stages, the risk of infection of the fetus is high, but the risk of complications is reduced.
Deviations may appear several years later and manifest themselves in retinal diseases, hearing impairment, pathologies of the endocrine system and other manifestations.
Rubella is especially dangerous for a child if the mother is infected in the first 12 weeks of pregnancy.
More than 50% of children are born with a diagnosis of CRS (congenital rubella syndrome), which is characterized by severe defects of the visual organs, defects of the cardiovascular system and hearing, and disturbances in the functioning of the digestive, urinary, reproductive and central nervous systems. When infected in the second trimester, the child is often diagnosed with deafness. In the later stages, infection of the fetus is unlikely.
Cytomegalovirus infection occupies a leading position in infecting the fetus during intrauterine development. The risk to the embryo occurs when the mother becomes infected during pregnancy.
Cytomegalovirus infection causes fetal death or the development of congenital forms of diseases in a child (hepatitis, jaundice, pneumonia, heart defects, deformities).
Such children may exhibit defects in psycho-emotional and physical development, pathologies of the hearing organs, epilepsy, and muscle weakness.
When infected with the herpes virus in the first 20 weeks after conception, the risk of miscarriage increases, and in the later stages it causes premature labor.
A newborn child is often diagnosed with congenital herpes with characteristic symptoms (jaundice, enlarged spleen and liver, defects in the functioning of the central nervous system).
When infected in early pregnancy, the herpes virus carries a mortal danger to the developing fetus.
The most important step in the fight against TORCH viruses is timely detection. With early diagnosis, there is no danger of infection of the fetus, and therefore no complications in development.
Why are TORCH infections dangerous?
When infected in the early stages, intrauterine fetal death is most often observed.
When exposed to infection at a later stage, the development of intrauterine infection and fetal abnormalities of varying severity are predominantly observed.
For reference. Infection with toxoplasmosis in the early stages most often leads to miscarriage and miscarriage. Congenital toxoplasmosis in children is manifested by severe eye damage (congenital forms of cataracts, glaucoma, optic nerve atrophy), brain damage (underdevelopment, cysts).
Hepatitis, meningoencephalitis, and generalized damage to internal organs may also occur.
Herpetic infections of types 1 and 2 lead to intrauterine damage to the fetal nervous system, damage to the gastrointestinal tract, the development of a necrotic rash in newborns, severe herpetic pneumonia, the development of thrombocytopenia and bleeding (up to disseminated intravascular coagulation syndrome), and the development of sepsis.
Cytomegalovirus infection is accompanied by severe intrauterine damage to the brain and eyes of the fetus, the development of hepatitis, pneumonia and carditis in newborns.
Congenital rubella leads to severe damage to the cardiovascular system (congenital heart defects), the development of congenital deafness and eye defects.
Mycoplasma infection in newborns most often leads to the development of severe pneumonia.
Chlamydial infections are accompanied by the development of pneumonia, vulvitis, urethritis, proctitis, conjunctivitis, nasopharyngitis, etc.
What is the danger
Diseases related to TORCH infections penetrate the placental barrier, entering the amniotic fluid. Infection of the fetus is possible through ingestion of amniotic fluid, and during childbirth, through the entry of fluid into the baby’s body.
A particular danger arises when the pathogen is identified within 12 weeks. It is during this period that the formation of all vital systems and organs occurs.
- Sometimes the cause of spontaneous abortion in the first trimester is IUI.
- Women expecting a new addition to the family are encouraged to register with the antenatal clinic before 12 weeks of gestation for a full examination and identification of pathologies.
- The consequences of infection are expressed in the child's mental retardation, physical underdevelopment and defects incompatible with life.
Rubella, classified by pediatricians and infectious disease doctors as a “childhood infectious disease,” is often harmless at an early age. Symptoms of the disease resemble a common acute respiratory infection - a slight increase in temperature, cough, sore throat and sore throat. In addition, patients experience the appearance of a small-spotted, bright pink, profuse rash on the skin and enlarged lymph nodes. The disease is treated symptomatically and usually leaves no complications.
The danger of rubella transmitted during pregnancy is that in almost 100% of cases this infection is transmitted from mother to fetus. Intrauterine rubella can affect almost every unborn baby, but the most common occurrences are:
- Greg's triad - cataracts, deafness (due to damage to the inner ear), congenital heart disease (patent ductus bottalus or VSD).
- Blood diseases - hemolytic anemia, thrombocytopenia.
- Hydrocephalus, microcephaly, dementia.
- Pathologies of skeletal formation, cleft lip and cleft palate.
- Hepatomegaly, congenital jaundice.
- Pathologies of the genitourinary system.
In about a quarter of pregnant women, rubella causes early miscarriage or stillbirth. The earlier the start date of gestation at which the disease manifested itself, the more likely the possibility of developmental defects in the baby or an unfavorable outcome of the pregnancy itself.
If a woman had rubella in childhood and was vaccinated as an adult (6 months before pregnancy), she and her baby are not in danger. However, it is still recommended to take a test to determine the level of antibodies to the rubella virus when planning pregnancy. When the female body’s defenses are insufficient, the specialist recommends vaccination.
When to get tested
It is recommended to take a blood test for TORCH infections at the planning stage. If a patient has immunoglobulin M (an indicator of acute infection) or high titers of immunoglobulin G (indicative of a relapse of a previous infection), treatment is prescribed, and then, after its completion, a repeat analysis is required.
If the patient does not have Ig G for chickenpox and rubella, vaccination may be recommended (in this case, planned pregnancy is allowed no earlier than three months after vaccination).
It is extremely difficult to examine a fetus for TORCH. Therefore, a pregnant woman undergoes testing for TORCH, especially this examination is important for women at risk.
During pregnancy, a blood test for TORCH infections is indicated:
- when registering a woman (it is advisable to perform the first analysis at up to 15 weeks);
- on the line from 24 to 26 weeks;
- from 34 to 36 weeks.
Also, a hemotest for TORCH infection is required before the IVF procedure.
Additionally, a mandatory ultrasound examination of the fetus is performed.
Diagnosis of TORCH infections
Source: Fotolia
Modern medicine, alas, has not yet learned how to fight viruses. The only exceptions are the herpes virus and the influenza virus, but even here everything is not so simple. However, it is quite possible to determine infection using a laboratory method. Using a blood test, laboratory technicians determine the presence and titer (quantity) in the blood of the expectant mother of specific compounds produced by cells to fight infection - immunoglobulins.
Immunity - a complex and well-functioning system of defense of our body - in response to the penetration of foreign objects, viruses, bacteria, begins an active fight against them, and different immunoglobulin molecules perform specific functions. Thus, the presence of IgG immunoglobulin is an indicator that the mother already has immunity in her body, however, if the titer (quantity) of IgG increases, it means that the infection occurred recently and the risk for the unborn child still exists. If the mother has stable immunity to diseases from the TORCH group, the child is not in danger.
Dangerous and risky situations occur when IgM is present in the blood - it appears at the time of infection and is present in the blood for some time until it is replaced by IgG. The lack of antibodies to Torch infections is also alarming - this means that when carrying a baby you need to be extremely careful so as not to catch a dangerous infection.
At the stage of pregnancy planning, you can get a vaccination, which will trigger the development of immunity.
IMPORTANT! Pregnancy is in most cases not a contraindication for vaccination. It is prohibited to vaccinate expectant mothers only with so-called live vaccines. In any case, you should not decide on your own to vaccinate against any infections - be sure to consult your doctor!
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TORCH infections how to get tested
A test for TORCH is prescribed by a doctor from a antenatal clinic or a gynecologist (reproductologist) who is seeing a woman planning a pregnancy.
The classic study for TORCH includes an analysis for antibodies to toxoplasma, rubella virus, as well as herpes simplex viruses (type 1 and 2) and cytomegalovirus infection.
If necessary, the doctor prescribes additional tests for gonorrhea, syphilis, chickenpox, chlamydial infection, mycoplasma, etc.
The interpretation of tests for TORCH infection is carried out by the attending physician who issued the referral for the study. Independent interpretation of results and independent prescription of treatment are unacceptable.
No specific preparation for analysis is required. Blood is donated in the morning on an empty stomach. Venous blood is used for analysis.
Preparing for analysis
Blood sampling is carried out in the morning on an empty stomach (after an overnight fast for 8-12 hours). It is permissible to drink a small amount of water before the test.
On the eve of the test, it is necessary to avoid physical, psycho-emotional, and food stress, and stop eating fatty, smoked, fried foods, and alcohol. If you are taking medications before undergoing tests, you must check with your doctor whether it is necessary to discontinue the medications before the test.
If the material for research is taken from the genital tract, sexual contact should be excluded for 1-2 days before the test; vaginal suppositories, ointments, and douching should not be used the day before.
TORCH infections during pregnancy transcript
Interpretation of tests includes assessment of the levels of immunoglobulins class M and G to pathogens of TORCH infections.
Acute infection is indicated by the detection of immunoglobulins M, and a relapse of a previously suffered infection is indicated by an increase in the level of immunoglobulins G.
With an increase in the level of immunoglobulin G, the risk of fetal damage is lower than with a high level of immunoglobulin M.
| Antibody class | Concentration | Unit change | |
| 1 | lgA | 0,35-3,55 | g/l |
| 2 | lgG | 7,8-18,5 | g/l |
| 3 | lgM | 0,8-2,9 | g/l |
It should be noted that the results of the studies are not interpreted separately. The level of immunoglobulin M should always be assessed in conjunction with the level of immunoglobulin G.
Signs of TORCH infection in a newborn
Signs of intrauterine infection of the fetus may be:
- • prematurity;
- • underweight;
- • development in the first days of life of pneumonia, urethritis, herpetic rashes, conjunctivitis, nasopharyngitis;
- • congenital heart defects;
- • congenital eye defects;
- • congenital deafness;
- • severe jaundice of newborns;
- • fever and intoxication;
- • swelling;
- • convulsions and tremors of the limbs;
- • shortness of breath;
- • cyanosis;
- • small head size;
- • lethargy of the child, lack of reflexes.
Attention. If an intrauterine lesion is suspected, the child is prescribed tests for rubella, toxoplasmosis, and cytomegalovirus.
