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TORCH INFECTIONS DURING PREGNANCY Part 01

TORCH INFECTIONS DURING PREGNANCY 

TORCH is an acronym that is used to describe the more common fetal infections :
  • T oxoplasmosis
  • O ther, which refers to syphilis and HIV infection principally, but may also refer to gonorrhoea and varicella
  • R ubella
  • C ytomegalovirus
  • H erpes, and also hepatitis
Toxoplasmosis

  1. protozoal infection (Toxoplasma gondii)
  2. incidence: 1/1000 pregnancies
  3. source: raw meat, unpasteurized goatís milk, cat urine/feces
  4. greatest risk of transmission in T3
  5. severity of fetal infection greatest in T1
  6. 75% asymptomatic at birth, but may later develop sequelae
  7. risk of congenital toxoplasmosis (chorioretinitis, hydrocephaly,intracranial calcifications, MR, microcephaly) if primary maternal infection during pregnancy 
  8. diagnosis based on serologic testing for both IgM and IgG
  9. confirmation of diagnosis based on presence of IgM antibodies in cord blood
  10. self-limiting infection, spiramycin (macrolide) decreases fetal morbidity

Rubella

  1. RNA togavirus with transmission by respiratory droplets (highly contagious)
  2. maternal infection during pregnancy (greatest in T1) may cause spontaneous abortion or Congenital Rubella Syndrome: hearing loss, cataracts, cardiovascular lesions, MR, symmetric IUGR, hepatitis, CNS defects and osseous changes
  3. diagnosis best made by serologic testing
  4. all pregnant women screened for rubella immunity (rubella titer > 1:16 = immune)
  5. non-immune
    • should be offered vaccination following pregnancy (not a contraindication for breast feeding)
    • rubella vaccine should be avoided before (3 months) or during pregnancy since it is an attenuated live vaccine
Cytomegalovirus

  1. DNA virus (herpes family)
  2. transmission:
    • blood transfusion
    • organ transplant
    • sexual contact
    • breast milk
    • transplacental
    • direct contact during delivery
  3. congenital infection can occur from primary or re-infection of the mother
  4. increased fetal morbidity with primary infection
  5. risk of transmission constant across trimesters
  6. 5-10% of fetuses infected in utero will develop neurologic involvement (MR, cerebral calcification, hydrocephalus or microcephaly, deafness, chorioretinitis)
  7. diagnosis:
    • isolation of virus in urine culture (or culture of other secretions)
    • serologic screening for antibodies
TORCH INFECTIONS DURING PREGNANCY Part 01 TORCH INFECTIONS DURING PREGNANCY Part 01 Reviewed by Radiology Madeeasy on January 03, 2011 Rating: 5
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