About two to three percent of congenital malformations of the fetus occur in perinatal infections. Most of them during primary infection are dangerous during pregnancy, and relapses of herpes can be a threat during childbirth or the postpartum period. TORCH is an abbreviation, an abbreviation for intrauterine infections that develop most frequently and pose a great danger to the fetus.
TORCH infections during pregnancy. Decoding abbreviations
- T is toxoplasmosis (toxoplasmosis).
- O - other infections (others), which are understood as hepatitis B, C, chlamydia, listeriosis, syphilis, parvovirus and gonococcal infections. Also recently, the list has been supplemented with chickenpox, HIV, enterovirus infection.
- R is rubella (rubella).
- C - cytomegalovirus (cytomegalovirus).
- H is herpes.
There is also a version that TORCH infections during pregnancy include only four of the above diseases, and the letter “O” in the abbreviation is not interpreted as others, but simply appears as the second letter in the word toxoplasmosis.
Use of the term
As we know, rubella, cytomegalovirus, toxoplasmosis, and herpes infection can affect anyone. TORCH is a term that is used not with respect to all people, but only with reference to those preparing for pregnancy and pregnant women, the fetus, and the newborn. Usually, for the first time, a meeting with the listed infections occurs in childhood or adolescence. After the initial infection, immune defense is produced. If a woman first became infected during pregnancy, the fetal organs and systems (especially the central nervous system) can be adversely affected, which increases the risk of spontaneous abortion, congenital malformations, stillbirths, and malformations.
If a pregnant woman develops an infection of the TORCH complex, microbes that can enter the body of the child begin to circulate actively in the blood. If this happens, you often have 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 performed.
Diagnostics
In order to avoid complications in the future, it is recommended even before pregnancy or in the first trimester to undergo an examination to find out if you already had a primary infection with TORCH complex infections or not. If it was, then you can breathe easy: there is no danger. If it wasn’t, you should take care of your own health and take a series of preventive measures. For example, when it comes to toxoplasmosis, certain rules must be followed, which will reduce the risk of infection; about rubella - you can get a vaccine, etc. Also, during pregnancy, you should regularly monitor your health 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 an analysis for TORCH infection costs. The price of a comprehensive diagnosis varies from two to five thousand rubles.
Laboratory research
As already mentioned, often after infection there are no clinical manifestations. In some, the lymph nodes increase, the temperature rises, a rash appears, however, such signs are nonspecific, so diagnosis is not possible only through external examination.
Laboratory analysis for TORCH infection consists in determining the concentration (titers) of antibodies in the blood against pathogens of rubella, herpes, toxoplasmosis and cytomegalovirus. If antibodies are present, it means that a woman in the past has already suffered this ailment and has immunity to it. But if the antibody titer is very large or gradually increasing, then the process is active at this particular moment. If there are no antibodies at all, too early to rejoice. After all, there is always a risk of getting sick during pregnancy.
By the way, the severity of symptoms is in no way connected with the level of danger of the effect of microbes on the fetus. For example, there have been many cases when the disease was vivid in women, but the children remained healthy, and vice versa, when the patients did not observe any signs and the fruits were severely damaged.
Blood analysis
All species of mammals have five homologous classes of immunoglobulins, that is, they developed even before the separation of mammals into species. This suggests the need for antibodies to survive. Immunoglobulins are special proteins that are produced when the body encounters any pathological agent. Antibodies are specific, that is, they act only on a particular agent. To clarify specificity, the name of the pathogen against which they act is added to the designation of immunoglobulins (Ig).
So, five classes of antibodies are distinguished: IgM, IgG, IgA, IgD, IgE. The first three of them are the most important. In a laboratory test for TORCH infection, the decoding of the results is based on indicators of two classes of immunoglobulins: IgG and IgM. At various stages of the immune response, different antibodies appear. 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, to predict the risks and correctly prescribe treatment measures.
IgM and IgG Level
Shortly after the start of the pathological process, IgM increase, they reach their peak by the first or fourth week (depending on the type of infection), and then decrease within a few months. The significant presence of IgM in some infections can be quite long. And then an analysis of the avidity of IgG to the pathogen comes to the rescue (we will talk more about it 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 existing questions. Using such an analysis, it is possible to detect the absence or presence of the pathogen DNA in the body and even determine its type, but, for example, it will not be possible to distinguish a recent or acute infection from carriage of the virus. For research, blood, urine, discharge from the cervix or vagina are used. The accuracy of the results is 90-95 percent. The PCR method has proven itself in the diagnosis of 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 causative agent of the disease. The material for the study is the discharge from the cervix, vagina, urethra.
And yet, the most reliable results are given by a blood test for TORCH infection. After all, it is serum that contains antibodies . Based on the data obtained, the doctor can conclude what form of the disease the woman suffers (acute or chronic), to understand whether the disease is really active or the patient is only the carrier of TORCH infection. During pregnancy, blood needs to 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.
Preventative 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 appoints an additional examination. He also offers a preventive measures scheme. Pregnant women who do not have antibodies to a particular infection need to pay special attention to a healthy lifestyle during the period of bearing the child: move a lot, spend more time in the fresh air, take vitamins that strengthen the immune system, fully and properly eat. For the prevention of toxoplasmosis, you must additionally monitor compliance with hygiene rules, avoid contact with cats. Also, during pregnancy, you should regularly donate blood for TORCH infections, in order to have time to “intercept” them and take measures. Next, we will talk more about the effect of each specific pathology on the body.
Toxoplasmosis
This infection of TORCH complex is extremely rare during pregnancy. Although in general the disease is very common, according to some reports, 30 percent of all people in the world suffer from it. The causative agent is toxoplasma - a parasite, the primary owner of which is a domestic cat - in its body the parasite multiplies and then is released into the external environment. You can get infected through meat (undercooked or raw), dirty hands. If a person has good immunity, then toxoplasmosis is not dangerous, you can get sick without even noticing it. This is the so-called one-time disease, to which, after the first infection, a stable immunity is developed.
The only situation when toxoplasmosis becomes dangerous is the initial infection with it during pregnancy. However, the probability of this, as already mentioned, is small. According to statistics, such an infection with TORCH complex during current pregnancy occurs in only 1 percent of women. If the infection occurred more than six months before the onset of conception, the fetus is not in danger. And if the infection happened later, the level of danger depends on the exact period of pregnancy toxoplasma penetrated into the body: the sooner, the higher the risk of serious consequences from infection of the fetus, 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 entails the development in a child of serious damage to the eyes, spleen, liver, nervous system, and sometimes leads to fetal death. Therefore, doctors usually recommend aborting artificially. This once again confirms the need to take an analysis for TORCH infection before conception. The results will show whether it is possible to become pregnant right now or whether to 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, pathology is easy and harmless, after which the body develops immune defense, 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, and nervous tissue of the fetus are affected. Infection in the first trimester is an absolute indication for terminating a pregnancy, but if the infection occurred later, there is usually no threat to the life of the child, but he may develop a variety of disorders, including developmental delay and growth retardation. Then it is necessary to carry out general strengthening therapy, prevention of placental insufficiency.
As in other cases, a study on antibodies to rubella should be carried out in advance, even in the process of planning pregnancy. The presence or absence of danger can be judged when a transcript of analyzes is done. 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 contacted a person with rubella. If signs of acute infection are detected, urgent need to take action.
Prevention of this viral disease cannot be prevented, so the best thing you can do to protect yourself is to get a vaccine. It should be vaccinated before pregnancy. The introduction of a vaccine is simply necessary for those women who do not have rubella antibodies in their blood. The modern vaccine has been improved to such an extent that it gives an almost absolute guarantee of protection and almost never causes negative effects, with the exception of a slight increase in temperature and redness at the injection site. The 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 healthy, the disease poses virtually no danger, but if weakened, the virus can affect almost all organs and systems. And yet, most people carry the infection very easily. The produced antibodies persist for life, so the disease never re-activates.
But if the primary infection occurs during pregnancy, the consequences can be disastrous. The situation is exacerbated by a 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 in the process of conception, because the sperm of a man also contains a pathogen. But this rarely happens, most often infection occurs either through the membranes or through the placenta. Even during childbirth, when passing through the birth canal, infection is possible, although this option is the least dangerous for the baby. But intrauterine infection is fraught with grave consequences: the fetus may die, or the baby will be born with a congenital pathology, which either immediately manifests itself with defects such as dropsy of the brain, jaundice, enlarged spleen or liver, brain underdevelopment, cardiac abnormalities, pneumonia, congenital malformations and so on, or makes itself felt only in the second or fifth year of life. A child may suffer from epilepsy, deafness, muscle weakness, mental and intellectual development retardation, cerebral palsy, and speech inhibition. Therefore, the identification of primary TORCH infection during pregnancy is an indication for its termination.
In the case when a woman became infected 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 antibodies to cytomegalovirus are absent, that is, the woman has not yet encountered this disease, during pregnancy she will be advised to undergo a new examination every month, which will not miss the fact of infection, if any.
If during a blood test it turns out that the expectant mother is a passive carrier of the infection, she will need to make additional efforts aimed at maintaining immunity in a healthy state. As already mentioned, not only mom, but also dad can “bestow” a child with a cytomegalovirus, 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 the so-called cold on the lips, and the second - most often affects the genitals (it is also called urogenital herpes). The infection is transmitted by air and sexually, in addition, through the placenta can pass from mother to fetus. If you start the condition, herpes can manifest itself not only with lesions of the mucous membranes and skin, but also with impaired functioning of the internal organs, eyes, and nervous system.
When a virus is infected, as in the case of other infections of the TORCH complex, antibodies are produced in the body that significantly inhibit the further progression of the pathological process. Therefore, herpes often causes symptoms only when the immune system is weakened. When infected during pregnancy, antibodies with the virus itself pass from mother to fetus, so in most cases there is no danger to the baby. The threat of life occurs if at the initial stage of pregnancy (when all systems and organs are laid in the unborn baby), 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 increases threefold.
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Finally
So, TORCH infections carry a huge danger if infection occurs during pregnancy. Adverse events can be prevented very simply: you should know in advance which infections you have antibodies to and which ones you don't. Based on the results, the doctor will inform you whether it is possible to become pregnant right now or whether to wait a little. Start taking care of the health of your future baby even before its conception occurs! All the best!