TORCH infections refer to a group of viruses, bacteria and protozoa that can infect pregnant women and cause harm to the fetus. The infections included are Toxoplasmosis, Rubella, CMV, Herpes, Syphilis, and Varicella-Zoster virus. If a woman is infected during pregnancy, especially in the first trimester, the infection can cross the placenta and infect the fetus, potentially causing abnormalities, birth defects, miscarriage or stillbirth. Common symptoms in the fetus include deafness, blindness, heart defects and developmental delays. It is important for pregnant women to be tested and take preventive measures such as vaccinations and good hygiene to avoid infection with these pathogens.

1. TORCH INFECTIONS
IN PREGNANCY
Prepared by,
Miss. Sandra P Mohan
4th year , BSc Nursing
GCON,EKM

2. What are TORCH Infections..?
• TORCH Complex is a medical acronym for a set of perinatal infections that
can lead to severe fetal anomalies or even death.
• They are a group of viral , bacterial and protozoan infections that can gain
access to the fetal blood stream transplacentally via the chorionic villi

3. What are TORCH Infections..?
• T - Toxoplasmosis
• O - Other infections
• R - Rubella
• C - Cytomegalovirus
• H - Herpes Simplex Virus
• Other infections – syphilis , varicella zoster , parvo virus

4. TOXOPLASMOSIS
• Protozoan infestation caused by Toxoplasma gondii
• This is an obligate intracellular protozoa
• Definitive host (sexual reproduction): Cat

6. TOXOPLASMOSIS
Major clinical features in humans are subclinical or mild such as:
• Fatigue , Fever
• Headache
• Maculopapular Rash
• Posterior cervical lymphadenopathy
• Encephalopathy
• Retinitis and choroiditis
• Hence pregnant women may not know whether they have acquired the
infection as symptoms are mostly mild.

7. TOXOPLASMOSIS
• Infection leads to lifelong immunity
• Infection during pregnancy Risk to Fetus by Vertical Transmission
• Risk of transmission increases with gestational age
• Max risk of transmission : 3rd trimester
• If fetus infected in 1st trimester – severe effects, but rare in occurence

8. TOXOPLASMOSIS
Diagnosis
• History Collection
• Serological testing
IgM : -ve , IgG : +ve – Past Infection
IgM : +ve , IgG : -ve ,High avidity - >4mnths old infection
IgM : +ve , IgG : -ve , Low avidity – recent infection
• Once Toxoplasmosis infection is confirmed in mother , Start
Spiramycin(3mg orally daily ) treatment to reduce vertical transmission

9. TOXOPLASMOSIS
Prenatal diagnosis of Fetal Infection & Treatment
• Amniocentesis and cordocentesis followed by PCR analysis
• Fetal USG for signs of Toxoplasmosis
• Once fetal infection is confirmed,
• Start Pyrimethamine ( 25mg orally daily) and Sulfadiazine ( 1g Q4H daily) for
treating Congenital Toxoplasmosis
PREVENTION: Uncooked meat , unpasteurized milk and contact with stray
cat or cat litter are to be avoided.

10. RUBELLA
• RNA virus , Togavirus family
• Infection occurs through droplets , aerosols , direct contact (Esp.
Nasopharyngeal secretions)
Maternal Infection – Rubella
• Mild febrile illness ,maculopapular rash , cervical lymphadenopathy
• ie, mostly asymptomatic

11. RUBELLA
Fetal Infection –Rubella
• Maternal infection in first 12 wks Congenital infection (90% cases)
• Defects are rare after 20 wks
• Features of congenital rubella include :
Deafness Micro-ophthalmia
Ventriculomegaly
Thrombocytopenic purpuric rash
Heart defects Cataract Diabetes

12. RUBELLA
Prevention Of Rubella
Take Rubella Vaccination
• If not sure , Test Anti-IgG for rubella – if result is –ve : You are susceptible and
hence should take vaccination
• Pregnancy should be avoided for at least 1 mnth (ideally 3 mnths ) after vaccination
as it is a live attenuated vaccine
• Now Rubella vaccine is included in Universal Immunization Schedule and is being
provided to children and adolescents as MMR Vacine

13. CYTOMEGALOVIRUS
• CMV – DNA virus ( Herpes family)
• Asymptomatic infection (mild flu like symptoms)
• Immunity is partial, reinfection can occur.
• CMV is the most common perinatal infection ( 1in 200 live births)
• Transmission – contact, sexual, resp. droplet, transplacental
• Virus is excreted in all body fluids (saliva, blood, urine, cervical secretions)

14. CYTOMEGALOVIRUS
Transmission to baby:
1. By vertical transmission
2. During delivery from infected birth canal
3. By breast feeding
• Risk of transmission increases during later part of pregnancy
• If transmission occurs in 1st trimester, severity in fetus increases.

15. CYTOMEGALOVIRUS
Consequences of infection in baby:
• Miscarriage, periventricular calcifications, hepatosplenomegaly
• Microcephaly, chorioretinitis, jaundice
• Petechial hemorrhages( blue berry muffin rash)
Late complications:
• Mental Retardation, Vision loss
• Sensorineural hearing loss
• Congenitally-affected infants may excrete virus (thr.urine and nasopharynx) for upto
5-7yrs.

16. CYTOMEGALOVIRUS
• Pregnant women usually aquires this disease from younger children. Hence
use safe hygienic practices.
Diagnosis:
• In antenatal period :
1. USG – If suspicious features appear in 2nd TRM
2. Serological test (IgG, IgM, IgG avidity)
• If maternal infection is confirmed – Invasive fetal testing can be done.

17. HERPES SIMPLEX
• Genital tract infection due to HSV-2
• Transmitted by sexual contact
• Infection may be primary, non primary, 1st episode or recurrent.
Effects on Pregnancy :
• Increased risk of miscarriage
• If Primary Infection acquired in last trm – Increased chance of premature
labor or IUGR.

18. HERPES SIMPLEX
• Transplacental infection is not usual
• The fetus becomes affected by virus shed from cervix or lower genital tract
during vaginal delivery
• The baby may be affected in utero from the contaminated liquor following
rupture of membranes
• Cesarean delivery is indicated in an active primary genital HSV infection
• Virus culture if + ve – Acyclovir 400 mg TDS -5days

19. HERPES SIMPLEX
• Neonatal infection may be disseminated, localized or asymptomatic
• Detection – Viral DNA by PCR
• S/S : chorioretinitis, microcephaly, mental retardation, seizures, death
• Breast feeding is allowed provided the mother avoids any contact between
her lesions, her hands and the baby.

20. SYPHILIS
• Sexually transmitted disease caused by spirochete Treponema pallidum
• Obligate human parasite
• Primary infection  Ulcer at the site of contact  Lymphatic channels
Blood stream  Attaches to arteries ( causes inflammation called
Endarteritis)  Disseminates to various other organs ( Secondary Infection)
• If no treatment is given, it will resolve on its own and becomes latent
spirochete. After many years the latent spirochete may produce Tertiary
Syphilis.

21. SYPHILIS
Clinical Features
• Primary Infection – Solitary, painless, deep ulcer with rolled and raised edges.
Base of ulcer indurated.
• Secondary Infection – diffuse maculopapular rash( palms and soles), fever,
malaise, headache, generalized lymphadenopathy.

22. SYPHILIS
Diagnosis:
• Obstetric history
• Clinical Features
• Investigations :
1. Serological testing :
• VDRL Test -} Non Specific
• RPR (Rapid Plasma Reagin) Test - }Non Specific

23. SYPHILIS
Specific Tests for Syphilis
• FTA- ABS (Fluorescent Treponemal Antibody Absorption) Test
• TP- PA( Treponema pallidum Passive Particle Agglutination) Test
• MHA –TP (Treponema pallidum microhemagglutination) Test
2. Detection of spirochetes from cutaneous lesion by dark field microscopy
3. Fetal infection can be diagnosed by PCR of T. Pallidum in amniotic fluid,
fetal serum or spinal fluid.

24. SYPHILIS
Adverse Pregnancy Outcome
• Fetal death
• Preterm labor
• Fetal growth restriction
• Hydropic enlarged placenta
Congenital Syphilis
• Early Features: Maculopapular rash, rhinitis, hepatosplenomegaly, jaundice,
lymphadenopathy, chorioretinitis, pneumonia
• Late Features: Hutchinson teeth, deafness, saddlenose, hydrocephalus, MR, clutton
joint, interstitial keratitis, optic nerve atrophy

25. SYPHILIS
Treatment for Mother
• Primary/Secondary/Latent syphilis (<1yr duration) :Benzathine penicillin
2.4million units I’M, single dose
• Duration >1yr :Benzathine penicillin 2.4million units IM weekly for 3doses.
• If allergic ; Oral azithromycin 2g single dose
• Tertiary disease: Neurosyphilis –Aq. Crystalline penicillin G 18-24 million units
IV daily for 10-14 days.

26. SYPHILIS
Treatment for Baby
• Positive serological reaction without clinical evidence: Single dose of Penicillin G
50,000 units/kg, IM
• Infected baby with positive serological reaction :
1. Isolation with the mother
2. Aq. Procaine penicillin G 50,000units/kg , IM, each day for 10 days
• An apparently healthy child of a known syphilitic mother: Serological reaction
weekly for first month and then monthly for 6mnths.

27. CHICKENPOX
• Varicella Zoster virus (DNA virus)
• Most of us are immune by virtue of infection or immunization.
• Primary infection(droplets, contact, aerosols) leads to chicken pox
• In some, virus becomes latent in neural system and gets reactivated after
years when immunocompromised. Now it is Herpes Zoster.

28. CHICKENPOX
What happens when a non immune pregnant mother gets Chicken pox?
• She can get chickenpox herself and transmit the virus to the fetus (vertical
transmission: highest risk : 13-20 wks of gestation)
• Diagnosis – PCR and ELISA
• For Mother – mostly conservative treatment. If severity increases, Oral acyclovir,
Valacyclovir are given. However this cannot prevent congenital infection.
• Also, Varicella ( live attenuated virus) vaccine is not recommended in pregnancy.

29. CHICKENPOX
Congenital Varicella Syndrome
• Characterised by: hypoplasia of limb,psychomotor retardation, IUGR,
chorioretinal scarring, cataracts, microcephaly, cutaneous scarring.
• Varicella Zoster Immunoglobulin (VZIG) should be given to newborn
exposed within 5 days.

30. PARVOVIRUS
• Parvovirus B 19(DNA virus)
• Fetal infection occurs by transplacental route( fetal infection occurs in 33%
of maternal infection cases)
• In mothers, infection is characterized by facial rash(slapped cheek
appearance).
• It can also affect erythroid precursor cells resulting in anemia,
thrombocytopenia, aplastic crises, congenital heart failure and hydrops

31. THANK YOU ❤