Analyzes for torch infection in pregnancy planning and early-onset - Causes, symptoms and treatment. MF.

Perinatal infections account for approximately 2-3% of all congenital abnormalities of the fetus. Most infections are dangerous for primary infection during pregnancy. Recurrences of herpes can be dangerous during labor and in the postpartum period.

What is ToRCH( infection) - infection

TORCH( infection) - infection , is the abbreviation for the most common intrauterine infections, very dangerous for the fetus. TORCH - Toxoplasma, Rubella, Cytomegalovirus, Herpes. In Russian: toxoplasmosis, rubella, cytomegalovirus and herpes.

The abbreviation TORCH stands for :

T - toxoplasmosis

O - other infections( others)

R - rubella

C - cytomegalovirus infection( cytomegalovirus)

H - herpes simplex virus

- others( other) - implies such fetal infections as hepatitis B and hepatitis C, syphilis, chlamydia, gonococcal infection, listeriosis, parvovirus( infection caused by parvovirus B19).Recently, this list included HIV infection, chicken pox, enterovirus infection.

However, as a rule, contains only four listed diseases: toxoplasmosis, rubella, cytomegalovirus and herpes. With this option, the letter O of the abbreviation stands for the second letter of the word toxoplasmosis.

All of them can affect people of any gender and age, but the term itself is used in relation to women who are preparing for pregnancy, pregnant women, as well as the fetus and the newborn. Rubella, toxoplasmosis, cytomegalovirus and herpetic infection are among the most common infections. In most cases, the first meeting with them occurs in childhood and adolescence - this is called primary infection, after which the immune defense remains. If the body meets the infection repeatedly, it is called a secondary infection or reinfection.

The peculiarity of THORG infections of is that when they are first infected by them during pregnancy, they can have a detrimental effect on all the systems and organs of the fetus, especially on its central nervous system, increasing the risk of miscarriage, stillbirth and congenital malformations of the child,, up to disability.

Often the infection of a pregnant woman with infections of the torch complex is a direct indication of the termination of pregnancy. TORCH( infections) - infections are dangerous by the development of deformities in the fetus or its death .

Than ToRCH infections are dangerous?

In pregnancy, a primary infection of any one of the group with TORCH infection is dangerous. That is, a meeting with the infection to which immunity has not been developed. Such infection is accompanied by a pronounced circulation in the blood of microbes that can enter the child's body.

An important feature of the infections of this group is that there may not be symptoms or they may be less pronounced. At this time, the infection will adversely affect the fetus and the course of pregnancy.

Why is a ToRCH screened?

It is up to pregnancy( or in early terms) we need to find out whether there was an infection or not. If there was - you do not have to worry, this infection is not dangerous for a pregnant woman. If not, the doctor will tell you about a package of preventive measures( for example, if it's rubella - you can get vaccinated if it's about toxoplasm - you can follow certain rules to reduce the risk of infection, etc.).In addition, for those infections to which there are no protective antibodies, it is important to carry out regular monitoring in order not to miss the infection.

How is the diagnosis made and how is the ToRCH infection screened?

The diagnosis only on clinical manifestations( rash, lymph node enlargement, temperature, etc.) often causes difficulties, since in most cases the symptoms are not very pronounced or nonspecific. More accurate is the laboratory diagnosis - the determination of antibodies in the blood

Diagnosis of ToRCH( TORCH) - infections

The blood for the presence of antibodies to TORCH infections is the most accurate to take before the pregnancy, when planning it.

The most dangerous for the fetus is the primary infection of with ToRCH infections during the pregnancy, , especially in its early stages, so if a woman tests for a torch infection before pregnancy in a woman's blood, antibodies to these infections are found, then a woman can easily become pregnant - her babyfrom this side, nothing threatens. If, before pregnancy, antibodies to infections of the TORCH complex are not detected, it means that the pregnant woman will need to take additional measures in order to protect herself and her future baby.

If, before the onset of pregnancy, tests for torch-infection were not commissioned, it is absolutely necessary to do so as soon as possible. Moreover, tests for TORCH infection need to be given regardless of the state of health of the pregnant woman, since most TORCH-complex infections are asymptomatic, and before the appearance of serious complications from the fetus, a pregnant woman may not even guess about their existence.

Diagnose TORCH infection of by examining the blood for the presence of antibodies to the causative agents of toxoplasmosis, rubella, cytomegalovirus and herpes. Determine the titers( concentration) of antibodies to the listed pathogens. If there are antibodies, this does not mean that a person is necessarily sick. This may mean that he once had an infection with this infection and has immunity to it. However, if the antibody titer to a certain infection is very high or increases with time, this already indicates the activity of the process. Moreover, clinically, the disease may not manifest itself or be manifested by dim, erased forms. The severity of the external manifestations of the disease is in no way connected with the danger of its impact on the fetus. With a pronounced disease, the fetus can remain healthy, and, on the contrary, in the absence of clinical manifestations, the fetus may suffer greatly.

And, if there is no immunity, then it's too early to rejoice. A woman who has had an infection from the TORCH complex before pregnancy is more likely to maintain a healthy fetus than a woman who first fell ill during pregnancy. Rubella in pregnancy is a direct indication for the termination of pregnancy.

Blood test for antibodies: details of

In all mammalian species, five classes of immunoglobulins are homologous, that is, these classes were formed before the mammalian species was divided into species. This indicates the optimality of their properties and the need for survival. Antibodies( immunoglobulins) are special proteins of the immune system that are produced when they meet with an agent. Antibodies are specific, that is, they act on a specific agent. To clarify the specificity for the designation of antibodies, the name of the pathogen against which the antibodies are directed is added. In this case, for example, we are talking about antibodies to rubella, parvovirus B19, toxoplasm and so on. International designation of immunoglobulins - Ig. The capital Latin letter after Ig denotes the class of immunoglobulins. There are 5 classes of such classes: M, G, A, E, D. Five classes of antibodies are distinguished, of which the most important are G, M, A( IgG, IgM, IgA).

For diagnostics of TORCH infections, IgM and IgG are significant. Different immunoglobulins appear at different stages of the immune response and are in the blood at different times, so their definition allows the doctor to determine the time of infection, and therefore, to predict the risks, correctly assign diagnostic and therapeutic procedures.

IgM increase soon after the onset of the disease, reach a peak at week 1-4( this is the average figure, there may be differences for different infections), then decrease for several months. For some infections, the duration of the presence of a significant amount of specific IgM antibodies can be quite large. In these situations, the IgG antibodies assay is helpful( see below).The rapid appearance of antibodies of IgM class allows to diagnose the acute form of the disease at the very beginning.

IgG is determined a little later( no earlier than 2 weeks after the onset of the disease), their levels increase more slowly than IgM, but they remain substantially longer( for some infections throughout life).An increase in IgG levels indicates that the body has already met with this infection.

The most common methods for detecting torch infections by diagnostic methods are ELISA( enzyme immunoassay) and PCR( polymerase chain reaction).

By the method of PCR it is possible to detect the presence or absence of DNA of the pathogen of infection in the body. Moreover, this method allows to identify the type of pathogen( for example, herpes I or II type).

For analysis by PCR, blood, vaginal or cervical secretions, urine can be used. PCR is characterized by high accuracy of the results obtained( 90-95%).The time from taking the material to the study until the results are usually not more than two days.

The PCR method has proven itself in the diagnosis of chronic and asymptomatic infections, it is very important that it can detect even a negligible amount of the causative agent of the infection.

However, the PCR method can not answer all questions regarding torch infections. For example, it is impossible to distinguish acute or recent infection from infection through PCR.For this, the ELISA method is used, based on the detection of antibodies to the causative agent of the infection.

In men, the material for the study is the discharge from the urethra;in women - discharge from the urethra, cervix, vagina.

However, more reliable results are obtained by a blood test, since it is the blood serum that contains antibodies to the causative agent of infections. According to which antibodies are detected and what is their concentration, the doctor makes conclusions about whether the patient suffers from an acute or chronic form of the disease or is simply the carrier of the infection. Of course, only the doctor can give an accurate interpretation of the tests for the torch infection, he will, if necessary, prescribe additional examinations and suggest a treatment regimen or measures for the prevention of TORCH infections.

Pregnancy

It is better to insure yourself in advance, that is, to take tests for TORCH infection before pregnancy. If necessary, you can get vaccinated. Only survive the necessary period after vaccination before conception of the child.

During pregnancy

It is necessary to pass tests on TORCH( TORCH) - infections. If the antibody titers for any infection are increased, it is necessary to examine the blood in the dynamics. If the antibody titer increases - the process is active, and there is a danger to the fetus. It is necessary to be treated and observe the development of the fetus especially carefully.

Analgeses for TORCH-infection is best not to give during pregnancy, but 2-3 months before the planned conception. In this case, if an acute or subacute form of infection is detected, the doctor will be able to prescribe an effective treatment without worrying that the medications can damage the fetus.

If during the examination it is found that antibodies to this infection from the TORCH complex in the body are there and their amount corresponds to the norm, then it will say that during pregnancy, the torch infection will not threaten the fetus.

Finally, if antibodies to torch infections are not found, during pregnancy, a woman will need to pay increased attention to preventive measures: take drugs that strengthen immunity, lead a healthy lifestyle, eat properly and eat well, move a lot, spend several hours inday in the open air.

In addition, there are additional measures to prevent toxoplasmosis - they include careful compliance with hygiene rules, avoiding contact with cats or the process of processing raw meat.

For the prevention of rubella a few months before the expected pregnancy, a woman is recommended to have an inoculation against rubella.

In addition to measures to prevent torch infections, the doctor will definitely recommend a woman who does not have antibodies to these diseases, undergo an additional examination for TORCH infection during pregnancy. This is absolutely necessary in order to "intercept" the initial primary infection in time and take appropriate measures. Recall that the analysis for infections such as cytomegalovirus infection and herpes, it is necessary to hand over not only to the woman planning a pregnancy, but also to her partner.

If it is not possible to pass tests for TORCH infection before pregnancy, it should be done at the earliest possible gestation period, because it is in the first few weeks of pregnancy that the primary infection with torch infections can be most dangerous in terms of fetal infection.

Read more about each of the torch infections and their effect on the body of a pregnant woman and fetus.

Toxoplasmosis is a very widespread disease that affects almost 30% of people in the world. Its causative agent is a microorganism called toxoplasma. The primary host of toxoplasma, in whose organism this parasite multiplies, is the domestic cat, which most often becomes the source of human infection.

In addition, infection with toxoplasma can occur through dirty hands( as children usually get into kindergartens), through raw or undercooked( undercooked) meat. For a person with healthy immunity, toxoplasmosis is not a danger - you can get sick without even noticing it. In addition, to toxoplasmosis, the human body produces stable immunity, so this is a "one-time" illness.

The only situation in which toxoplasmosis is a serious danger is the primary infection with toxoplasmosis during pregnancy. In fairness, it should be said that the probability of such infection is not great - according to statistics during pregnancy, no more than 1% of women are infected with toxoplasmosis, 20% of whom transmit toxoplasmosis to the fetus. But still one percent is one pregnant woman of a hundred - not too little, by and large.

It is also important that the danger poses only toxoplasmosis, which the woman contracted during the current pregnancy. This means that if a woman has already had toxoplasmosis before pregnancy( no less than six months before her), her future child does not threaten toxoplasmosis. Moreover, in a tragic situation, when a woman loses a child due to toxoplasmosis during pregnancy, in six months she may become pregnant, without fear of toxoplasmosis.

If during the pregnancy infection with toxoplasmosis did occur, much depends on the period of pregnancy of toxoplasma got into the body of a pregnant woman.

The earlier the gestation period was, the greater the risk of severe consequences when the fetus is infected with toxoplasmosis, but at the same time, the less likely it is that the infection will occur.

And, conversely, at a later gestation period, the percentage of toxoplasmosis transfer to the fetus is very high( about 70%), but the risk of severe fetal damage is reduced.

The most dangerous infection is considered toxoplasmosis in the first 12 weeks of pregnancy. In these cases, congenital toxoplasmosis often leads to the death of the fetus or to the development of severe lesions of the eyes, liver, spleen, as well as the nervous system( especially the brain) of the child. Therefore, when a toxoplasmosis is infected at the initial stage of pregnancy, a pregnant woman is often offered to make an artificial termination of pregnancy.

All this once again shows that the tests for the presence of antibodies to toxoplasmosis should be taken not during pregnancy, but before it: if these antibodies in the blood of a future mother are, then there is nothing to be afraid if the analysis shows a fresh infection, then you should wait six months, and then calmly become pregnant. If no antibodies are found, additional safety measures should be taken during pregnancy.

Toxoplasmosis refers to those diseases that are very easy to prevent, observing the basic rules of hygiene.

Of course, for a pregnant woman without antibodies to toxoplasmosis, these rules become particularly stringent. First, during pregnancy, there should be no contact with cats, especially young ones, because cats infected with toxoplasmosis, with age, also develop immunity to it. If the cat can not be attached to the acquaintances during the pregnancy of the hostess, then the pregnant woman, at least, should be freed from caring for her. If this is not possible, then all manipulations, especially with a cat toilet, should be carried out only in rubber gloves. The same goes for working with the land in the garden - if you can not abandon it altogether, then you need to work in gloves. All vegetables, fruits, greens should be washed thoroughly. Contact with raw meat should also be avoided, and meat dishes must be properly cooked or roasted. After any work in the kitchen, you should wash your hands with soap and water. If these rules are observed, the risk of getting infected with toxoplasmosis will almost disappear. However, for complete tranquility several times for pregnancy should be given an analysis for toxoplasmosis, and preferably in the same laboratory.

Rubella is an infectious viral disease transmitted to a healthy person from a patient most often by airborne droplets. Rubella refers to quite innocuous "childhood" infections, it usually does not lead to any serious consequences.

Rubella shows a small pink rash all over the body, raising the temperature to about 38 ° C.The general condition of the patient is satisfactory.

The guile of rubella is that infection often occurs during the incubation period, when the disease does not manifest itself and the person does not know that he is sick. However, after the rubella has been transferred, the human body produces stable immunity, so there is no secondary infection with rubella.

When infected with a rubella of a pregnant woman, this harmless infection becomes deadly to the fetus. In the early stages of pregnancy, the rubella virus most often affects the fetal nervous tissue, eye tissues, and the heart.

In the first trimester, rubella of a pregnant woman is an indication for abortion. If the rubella infection occurred in the second or third trimester of pregnancy, then such irreparable consequences for the fetus, as a rule, do not arise, but, nevertheless, it may be lagging behind in growth and other violations. In such cases, general restorative therapy, prevention of placental insufficiency is carried out.

Finally, when rubella is infected in the last month of pregnancy, a child can be born with rubella, after which it proceeds in the same way as in children who became infected after birth, and usually does not cause serious consequences.

Analyzes for antibodies to rubella must be given before the planned pregnancy. If the analysis shows that the woman has recovered from rubella before pregnancy, then from this side there is no danger to the fetus.

An analysis is mandatory for antibodies to rubella and if a pregnant woman has contact with a sick rubella. If this happened in the first trimester of pregnancy and the analysis shows signs of acute infection, the woman will be advised to terminate the pregnancy.

Since rubella infection can not be prevented with preventive measures, the most appropriate option is preventive vaccination. Make it necessary before pregnancy, and for pregnant women planning a pregnancy, in the blood of which there are no antibodies to rubella, vaccination is necessary.

Modern rubella vaccines are effective almost 100 percent and have virtually no side effects, not counting a slight increase in temperature and redness at the injection site. The immunity to rubella, which is produced after vaccination, lasts about 20 years.

Cytomegalovirus infection is a viral infectious disease discovered only in the 20th century, the causative agent of which is cytomegalovirus( CMV).

Cytomegalovirus can be transmitted sexually, through the blood, with breastfeeding. The effect of CMV on a person depends, first of all, on the state of the immune system: with healthy immunity, CMV is practically not dangerous, but if immunity is reduced, cytomegalovirus is activated and can affect almost all the systems and organs of the infected person.

Most people infected with CMV carry an infection without even noticing it. Antibodies to CMV are stable and persist for life, repeated diseases almost never occur.

However, just as with the rest of the torc infections, if the primary infection with cytomegalovirus occurs during pregnancy, the consequences can be catastrophic. The problem is exacerbated by the fact that the risk of intrauterine transmission of CMV is quite high - cytomegalovirus infection is one of the first places for intrauterine infection of the fetus. And the infection of the fetus can occur in different ways, and not only from the sick mother, but also from the father at the time of conception, since in the male sperm also contains CMV.

However, most often, CMV enters the fetus either through the placenta or through the membranes, that is, from the mother's body. Infection of the child can occur during childbirth, when passing through the mother's infected maternal pathways, and when breastfeeding, but this option is much less dangerous and does not lead to serious consequences for the child.

With intrauterine infection, a cytomegalovirus infection can result in fetal death or the birth of a child with congenital cytomegalovirus infection.

Congenital cytomegalovirus infection can occur immediately after the birth of the child with such malformations as an underdeveloped brain, hydrocephalus, hepatitis, jaundice, enlarged liver and spleen, pneumonia, heart defects, congenital malformations.

A born child may suffer from a delay in mental development, deafness, epilepsy, cerebral palsy, muscle weakness.

Sometimes congenital cytomegalovirus infection occurs only in the 2-5th year of life of an infected child with blindness, deafness, speech inhibition, mental retardation, psychomotor disorders.

All this leads to the fact that the primary cytomegalovirus infection in pregnant women in the early stages of pregnancy is an indication for the artificial termination of pregnancy.

If a woman has been infected with cytomegalovirus infection earlier, and during pregnancy her exacerbation has occurred, then such terrible consequences do not arise: a woman is prescribed treatment with antiviral drugs and immunomodulators.

Therefore, as in all cases of torch infections, an antibody test for cytomegalovirus should be performed before the onset of pregnancy. If antibodies are not found, the woman will be recommended to conduct a monthly blood test, which will not allow to miss the primary infection, the most dangerous for the fetus.

If antibodies to CMV are found and it turns out that a pregnant woman is a passive carrier of cytomegalovirus, then it is recommended to make additional efforts to maintain normal immunity. Recall also that CMV can "give" the child not only the mother, but also the father, therefore, not only the woman planning pregnancy, but the future father of her child should be screened for cytomegalovirus infection.

Finally, the latest of the infections of the TORCH complex is the herpes .Strictly speaking, herpes is not even a disease, but a whole group of viral infectious diseases.

There are two groups of herpes viruses - herpes I and II types.

Type I herpes, in particular, manifests itself as a common "cold" on the lips, type II herpes in most cases affects the genitals( the so-called urogenital herpes).

Herpes is transmitted by airborne and sexual route, and also "vertically", that is, from a pregnant mother, an infection through the placenta can pass to the fetus.

In case of advanced chronic course of the disease, both types of herpes can manifest as lesions not only of the skin and mucous membranes, but also of the central nervous system, eyes, internal organs.

As with all TORCH infections, when a person is infected with herpes, antibodies are produced in the person, which largely "jam" the further progression of the virus, and herpes is most often manifested only when immunity decreases( as, for example, cold sores for colds).If a woman has contracted herpes from pregnancy, then these antibodies pass to the fetus along with the virus, and most often the infection does not represent a hazard to the fetus.

When a primary infection with herpes during pregnancy, especially at its initial stage, when all the organs and systems of the unborn child are laid, herpes infection can be deadly to the fetus.

In this case, the risk of undeveloped pregnancy and miscarriages triples, and the fetus may develop ugliness. If infection with genital herpes occurs in the second half of pregnancy, the probability of congenital anomalies of the fetus such as microcephaly, retinal pathology, heart defects, congenital viral pneumonia increases. Preterm birth may occur.

In addition, infection of the fetal HSV during the fetal period can cause severe situations associated with the death of the child after birth, infantile cerebral palsy, epilepsy, blindness, deafness.

A child can get herpes not only in utero, but also during childbirth, passing through the birth canal of an infected mother. This occurs if during pregnancy a woman's genital herpes becomes aggravated, and rashes are localized on the cervix or in the genital tract. If, four weeks before the birth, the herpes virus is detected in a pregnant woman, the birth is usually performed by a planned caesarean section in order to minimize the risk of infection of the newborn.

The conclusion suggests itself: examination of a couple planning a pregnancy, for herpes, should also be carried out before pregnancy.

If the herpes virus is detected, the doctor will prescribe a treatment, after which the infection will not bother neither the future mother, nor the future baby. If necessary, the treatment of herpes is prescribed and during pregnancy, for this, antiviral agents that suppress the activity of the herpes virus, as well as drugs that strengthen the immunity of a pregnant woman, especially stimulating the production of an interferon by the body, are usually used.