Approximately two to three percent of congenital fetal anomalies are due to perinatal infections. Most of them, when initially infected, are dangerous during pregnancy, and relapses of herpes can pose a threat during childbirth or the postpartum period. TORCH is an abbreviation for intrauterine infections that develop most often and pose a great danger to the fetus.
TORCH infection during pregnancy. Abbreviation Explanation
- T is toxoplasmosis.
- O - other infections (others), which include hepatitis B, C, chlamydia, listeriosis, syphilis, parvovirus and gonococcal infections. Also, the list was recently supplemented with chickenpox, HIV, enterovirus infection.
- R is rubella (rubella).
- C – cytomegalovirus (cytomegalovirus).
- H is herpes.
There is also such a version that TORCH infections during pregnancy include only the four diseases listed above, and the letter "O" in the abbreviation does not stand for others, but simply acts as the secondletter in the word toxoplasmosis.
Use of term
As we know, any person can be affected by rubella, cytomegalovirus, toxoplasmosis, herpes infection. TORCH is a term that is not used in relation to all people, but only in relation to women preparing for pregnancy and pregnant women, the fetus and the newborn. Usually, the first meeting with the listed infections occurs in childhood or adolescence. After the initial infection, an immune defense is developed. If a woman is first infected during pregnancy, the organs and systems of the fetus (especially the central nervous system) can be adversely affected, which increases the risk of spontaneous abortion, congenital deformities, stillbirth, and malformations.
If a pregnant woman has any infection of the TORCH-complex, microbes begin to actively circulate in the blood, capable of entering the child's body. If this happens, it is often necessary to terminate the pregnancy. The situation is complicated by the fact that in most cases there are no pathological symptoms, and the problem is detected only when an examination for TORCH infection is carried out.
Diagnostics
To avoid complications in the future, it is recommended to undergo an examination before pregnancy or in the first trimester to find out whether you have already had a primary infection with TORCH-complex infections or not. If it was, then you can breathe easy: there is no danger. If not, you should take care of your own he alth and conduct a series ofpreventive measures. For example, if we are talking about toxoplasmosis, you must follow certain rules that will reduce the risk of infection; about rubella - you can get vaccinated, etc. Also, during pregnancy, you should regularly monitor your he alth status regarding those infections for which you do not have protective bodies in order to identify the problem in time if it suddenly appears. Many women are interested in how much a TORCH infection test costs. The price of complex diagnostics varies from two to five thousand rubles.
Laboratory studies
As already mentioned, often there are no clinical manifestations after infection. In some, the lymph nodes increase, the temperature rises, a rash appears, however, these signs are non-specific, so diagnosis only through an external examination is impossible.
Laboratory analysis for TORCH infection is to determine the concentration (titers) of antibodies in the blood to the pathogens of rubella, herpes, toxoplasmosis and cytomegalovirus. If antibodies are present, then the woman has already suffered this disease in the past and is immune to it. But if the antibody titer is very high or gradually increases, then the process is active at this particular moment. If there are no antibodies at all, it’s too early to rejoice. After all, there is always a risk of getting sick during pregnancy.
By the way, the severity of symptoms has nothing to do with the level of danger of exposure to microbes on the fetus. For example, there are many cases where the disease had vivid manifestations in women, but childrenremained he althy, and vice versa, when the patients did not observe any signs in themselves, and the fetuses were badly damaged.
Blood test
All mammalian species have five homologous classes of immunoglobulins, that is, they were formed even before the division of mammals into species. This suggests the need for antibodies to survive. Immunoglobulins are special proteins produced when the body encounters a pathological agent. Antibodies are specific, that is, they act only on a specific agent. To clarify the specificity, the name of the pathogen against which they act is added to the designation of immunoglobulins (Ig).
So, there are five classes of antibodies: IgM, IgG, IgA, IgD, IgE. The first three of them are the most important. In a laboratory study for TORCH infection, the interpretation of the results is based on the indicators of two classes of immunoglobulins: IgG and IgM. Different antibodies appear at different stages of the immune response. They are present in the blood at different times, which makes it possible for a specialist, after analyzing the data that the analysis showed for TORCH infection, to determine the time of infection, predict risks and correctly prescribe therapeutic measures.
IgM and IgG levels
Shortly after the onset of the pathological process, IgM increases, they reach their peak by the first to fourth week (depending on the type of infection), and then decrease over several months. The duration of the presence of IgM in a significant amount with someinfections can be quite long. And then the analysis for the avidity of IgG to the pathogen comes to the rescue (we will talk about it in more detail below).
The rapid appearance of IgM in the blood makes it possible to diagnose the disease at the very beginning. IgG appear a little later - by the third week after infection; their level grows more slowly, but they remain in the blood much longer (with some infections they remain for life).
Polymerase chain reaction (PCR) and enzyme immunoassay (ELISA)
PCR can effectively detect TORCH infections. Deciphering the results, however, does not always provide answers to the existing questions. With the help of such an analysis, it is possible to detect the absence or presence of the DNA of the pathogen in the body and even determine its type, but, for example, it will not be possible to distinguish a recent or acute infection from the carriage of the virus. For research, blood, urine, discharge from the cervix or vagina is used. The accuracy of the results obtained is 90-95 percent. The PCR method has proven itself in diagnosing asymptomatic and chronic infections. What is characteristic (and very important), it allows you to determine even the smallest amount of the pathogen.
ELISA is used when it is necessary to find out at what stage the pathological process is. ELISA is based on the determination of antibodies to the pathogen. The material for the study is discharge from the cervix, vagina, urethra.
And yet the most reliable results are obtained by a blood test for TORCH infection. After all, it is blood serum that contains antibodies. On theBased on the data obtained, the doctor can conclude which form of the disease the woman suffers from (acute or chronic), understand whether the disease is really active or the patient is only a carrier of TORCH infection. During pregnancy, the blood must be examined in dynamics, only in this way it will be possible to obtain the correct results. If the antibody titer is rapidly increasing, then there is a danger.
Preventive measures
Only a doctor can accurately interpret tests for TORCH infection. Decryption requires certain knowledge, and you yourself are unlikely to be able to understand what's what. If necessary, the specialist prescribes an additional examination. He also offers a scheme of preventive measures. Pregnant women who do not have antibodies to a particular infection need to pay special attention to a he althy lifestyle during the period of bearing a child: move a lot, spend more time in the fresh air, take immunity-strengthening vitamins, eat fully and properly. To prevent toxoplasmosis, you additionally need to follow the rules of hygiene, avoid contact with cats. Also, during pregnancy, you should regularly donate blood for TORCH infections in order to have time to "intercept" them in case of something and take action. Next, we will talk in more detail about the effect of each specific pathology on the body.
Toxoplasmosis
This TORCH complex infection is extremely rare in pregnancy. Although the disease is very common in general, according to some estimates, 30 percent suffer from it.all people in the world. The causative agent is Toxoplasma, a parasite whose primary host is a domestic cat - the parasite multiplies in its body and then is released into the external environment. You can become infected through meat (undercooked or raw), dirty hands. If a person has good immunity, then toxoplasmosis is not dangerous, it can be ill without even noticing it. This is the so-called one-time disease, to which, after the first infection, a strong immunity is developed.
The only situation when toxoplasmosis becomes dangerous is the primary infection with it during pregnancy. However, the probability of this, as already mentioned, is small. According to statistics, such an infection of the TORCH complex during the current pregnancy occurs in only 1 percent of women. If the infection occurred more than six months before the onset of conception, nothing threatens the fetus. And if the infection happened later, then the level of danger depends on at what specific period of pregnancy Toxoplasma entered the body: the earlier, the higher the risk of developing severe consequences when the fetus is infected, but the lower the likelihood that this infection will occur at all.
Infection in the first twelve weeks is considered the most dangerous. In such cases, toxoplasmosis often leads to the development of serious lesions in the child's eyes, spleen, liver, nervous system, and sometimes leads to the death of the fetus. Therefore, doctors usually recommend artificially terminating the pregnancy. This once again confirms the need to be tested for TORCH infection even before conception. The results will show whetherget pregnant now or wait six months.
Rubella
This viral disease is usually transmitted through saliva, manifested by the appearance of a rash on the body and an increase in temperature. As a rule, the pathology proceeds easily and harmlessly, after which the body develops immune defenses, and secondary infection can no longer be feared. Another thing is when infection occurs during pregnancy. All TORCH infections in children can lead to the development of disorders, but rubella is simply deadly. At the initial stage, the eyes, heart, nervous tissue of the fetus are affected. Infection in the first trimester is an absolute indication for termination of pregnancy, but if infection occurs later, there is usually no threat to the life of the child, but he may develop a variety of disorders, including developmental and growth retardation. Then you need to carry out restorative therapy, prevention of placental insufficiency.
As in other cases, testing for antibodies to rubella should be carried out in advance, even in the process of planning a pregnancy. The presence or absence of danger can be judged when the decoding of the analyzes is made. TORCH infections, including rubella, are easy to diagnose - everything will show the level of immunoglobulins in the blood. It is mandatory to conduct an examination if a woman has been in contact with a person with rubella. If signs of acute infection are detected, urgent action must be taken.
Prevention of this viral disease cannot be prevented, so the best that can beto do in order to protect yourself - to vaccinate. It should be vaccinated before pregnancy. The introduction of the vaccine is simply necessary for those women in whose blood there are no antibodies to rubella. The modern vaccine has been improved so much that it gives an almost one hundred percent guarantee of protection and almost never causes negative effects, with the exception of a slight increase in temperature and redness at the injection site. Immunity developed after vaccination lasts for twenty years.
Cytomegalovirus
This TORCH infection in pregnant women is an order of magnitude more common than others, although in general this disease was discovered only in the twentieth century. Cytomegalovirus is transmitted through the blood, sexually, with mother's milk. The degree of influence on the human body will depend on the state of immunity: if it is he althy, the disease is practically not dangerous, but if it is weakened, the virus can affect almost all organs and systems. Yet most people carry the infection very easily. The antibodies produced last for life, so the disease never reactivates.
But if the primary infection occurs during pregnancy, the consequences can be catastrophic. The situation is aggravated by the high risk of intrauterine transmission of cytomegalovirus to the fetus. By the way, infection of the fetus can occur not only from the mother, but also from the father even in the process of conception, because the man's sperm also contains the pathogen. But this rarely happens, most often infection occurs either through the fetal membranes or through the placenta. Even induring childbirth, when passing through the birth canal, infection is possible, although this option is the least dangerous for the child. But intrauterine infection is fraught with serious consequences: the fetus may die, or the child will be born with a congenital pathology, which either immediately manifests itself with such defects as dropsy of the brain, jaundice, enlargement of the spleen or liver, underdevelopment of the brain, abnormalities in the heart, pneumonia, congenital deformities and so on, or makes itself felt only by the second or fifth year of life. The child may suffer from epilepsy, deafness, muscle weakness, mental and intellectual retardation, cerebral palsy, and speech inhibition. Therefore, the detection of primary TORCH infection during pregnancy is an indication for its termination.
In the event that a woman became infected even before conception, and in the process of bearing a child, an exacerbation of the disease occurred, such terrible consequences as described above do not occur. If during the analysis it is determined that there are no antibodies to cytomegalovirus, that is, the woman has not yet encountered this disease, during pregnancy she will be recommended to undergo a new examination every month, which will allow not to miss the fact of infection, if any.
If a blood test reveals that the expectant mother is a passive carrier of the infection, she will need to make additional efforts to maintain a he althy immune system. As already mentioned, cytomegalovirus can “give” a childnot only mom, but also dad, so a man should also be examined for antibodies.
Herpes
It should be noted that herpes is not even a disease, it is a whole group of viral diseases. The virus of the first type manifests itself in the form of a so-called cold on the lips, and the second - most often affects the genitals (it is also called urogenital herpes). The infection is transmitted through the air and sexually, in addition, it can pass through the placenta from mother to fetus. If you start the condition, herpes can manifest itself not only by lesions of the mucous membranes and skin, but also by disturbances in the functioning of internal organs, eyes, and the nervous system.
When infected with a virus, as in the case of other infections of the TORCH-complex, the body produces antibodies that largely suppress the further progression of the pathological process. Therefore, often herpes causes symptoms only when the immune system is weakened. When infected during pregnancy, antibodies, along with the virus itself, pass from the mother to the fetus, so in most cases there is no danger to the child. A threat to life occurs if, at the initial stage of pregnancy (when all systems and organs are laid in the unborn child), the mother is initially infected with the virus. In such a situation, the risk that the fetus will die or the baby will be born with congenital anomalies or deformities triples.
When an infection with urogenital herpes occurs in the second half of pregnancy, the likelihood that a child will be born withdevelopmental anomaly, for example, with retinal pathology, microcephaly, congenital viral pneumonia, heart disease, cerebral palsy, blindness, epilepsy, deafness. Preterm labor may also occur. If the fetus was not infected during the prenatal period, this can happen directly during childbirth, at the time of passage through the birth canal. This is possible if, in the process of bearing a child, a woman's genital herpes worsened and the rash was localized in the area of \u200b\u200bthe internal genital organs and cervix. As a rule, if such a situation is detected a month before the expected birth, the woman is given a caesarean section in order to minimize the risk of infection of the baby.
The conclusion here will be the same as in the previous cases: you need to be examined even before conception, while both partners should take the analysis. If an infection is detected, the doctor will prescribe treatment, after which it will be possible to become pregnant. In this case, you will be sure that the virus will not bother you or the baby.
In conclusion
So, TORCH infections are of great danger if the infection occurs during pregnancy. Preventing adverse events can be very simple: you should find out in advance which infections you have antibodies to and which you do not. Based on the results obtained, the doctor will tell you whether it is possible to become pregnant now or whether it is worth waiting a bit. Start taking care of the he alth of your unborn baby even before his conception occurs! Good luck!
