Anirban Das

When we talk about infections in pregnancy, we have different types of infections.  Some of them could be predominantly fetal infections that cause congenital malformations among which the TORCH group of infections is well known.  Some of the infections could be both fetal and maternal infections like HIV, HBsAg, and HCV while some of them could have predominantly maternal affections in hepatitis E virus and influenza.

TORCH infections can cause spontaneous abortions, preterm births, intrauterine growth restriction, and structural anomalies in the fetus, stillbirth, low birth weight, and persistent neonatal infections. Clinical signs and symptoms of maternal torch infection like fever, rash, exposure or contact, lymphadenopathy, unexplained hematological dyscrasias, ultrasound marker. So, congenital TORCH like early-onset fetal growth restriction or a severe early-onset fetal growth restriction, symmetrical or associated sonographic markers like echogenic bowel, calcification in brain, liver, or hydrops or screening in the targeted high-risk group so that literally brings us to the fact that unless there is an indication to screen for TORCH.  The epidemiological factors for toxoplasma would be the people who are raw meat consumption, unwashed home garden products, exposure to cats in surroundings. While exposure to rubella-infected patients and CMV, CMV is the most common TORCH infection and HSV high-risk sexual behavior so some of the epidemiological factors are these.

ACOG recommends screening for rubella at the first prenatal visit and IgG only is recommended and alone is sufficient to establish immunity so if IgG is positive we know that the patient is rubella immune and we need not worry about rubella infection.  Now if IgM is positive then it should not be done alone because IgM is suggestive of acute infection and sometimes it is false positive also so we should always combine IgM with IgG so if possible in our settings also rubella is something that should be possibly offered preferably in the pre-conceptional period rather than in pregnancy because then we have the option of vaccinating for rubella.  Now routine screening for CMV is not recommended by ACOG and SMFM.  Toxoplasmosis is not recommended in India. However, as mentioned in some countries like France routine screening is done due to the high prevalence of toxoplasmosis.

You can find out more details by enrolling in TORCH infection: The current perspective by Dr. K. Aparna Sharma (MD, DNB, FICOG, MNAMS), here, https://docmode.org/torch-infection-the-current-perspective-dr-k-aparna-sharma/