I. About Eugenics TORCH Screening
1. What is TORCH screening?
TORCH screening is to check whether a woman preparing for pregnancy has maternal infection with toxoplasma, rubella, cytomegalovirus, herpes simplex virus and other pathogens. The indicators to be observed are the presence of antibodies to the above pathogens – IgG and IgM – in the maternal serum; IgG represents a distant infection, which does not require treatment and can lead to pregnancy; IgM represents a recent infection, which requires treatment and pregnancy is appropriate.
2.What does TORCH mean? When is the right time to get tested?
TORCH is the abbreviation of several viruses, T stands for Toxoplasma gondii infection, R stands for rubella virus infection, C stands for cytomegalovirus infection, H stands for herpes simplex virus infection, O stands for others, such as hepatitis B virus, HIV virus, syphilis spirochete, etc. TORCH can infect the fetus through the placenta and birth canal, causing intrauterine infection, miscarriage, intrauterine growth retardation, still birth, congenital TORCH can cause intrauterine infection, miscarriage, intrauterine growth retardation, stillbirth, congenital malformation, neonatal infection, and even developmental disorders during puberty.
After TORCH infection, patient-specific antibodies IgM and IgG can rise rapidly, with IgM appearing early and lasting 6-12 weeks, while IgG appears late but can be maintained for life. Therefore, we often consider a positive IgG as a previous infection, and a positive IgM as a diagnostic indicator of the first infection. tORCH screening is best done 2-3 months before pregnancy, and if the IGM antibody is positive, treat it before pregnancy, and if necessary, review it again in early pregnancy.
3.What is the effect of TORCH on mother and child?
Toxoplasma gondii is a zoonotic disease in which cats and other animals are the source of infection. Acquired infection is often asymptomatic in light cases, but antibodies can be detected in the serum; heavy cases can cause various symptoms, such as high fever, muscle or joint pain, swollen lymph nodes, etc.; intrauterine infection through the placenta can cause stillbirth, abortion or premature birth, and after birth can show a series of central nervous system symptoms and congenital damage to eyes and internal organs.
Rubella infection in pregnant women mostly in the first to sixth weeks of pregnancy, in addition to miscarriage, embryonic death, the resulting infant can also occur congenital rubella syndrome, causing fetal congenital cataracts, deafness, microcephaly and risk of cardiac malformation. lgM antibody positive indicates a recent infection, if necessary, the pregnancy should be terminated.
Cytomegalovirus lgM antibody positivity suggests that the patient has a recent cytomegalovirus infection, but should be analyzed specifically in the context of the clinical situation, which can cause fetal central nervous system and retinal dysplasia in severe cases.
Herpes simplex virus mainly causes herpes stomatitis, eczematous herpes, herpes keratoconjunctivitis, neonatal herpes, herpes vulvovaginitis, etc. Infections outside the genital organs are mostly caused by herpes simplex virus – type I, while infections in the genital organs are mostly caused by herpes simplex virus – type II. TORCH screening cannot distinguish between herpes simplex virus – type I or herpes simplex virus – type II. lgM antibody Positive lgM antibody indicates recent herpes simplex virus infection, which can cause miscarriage, preterm delivery or fetal malformation in severe cases.
Syphilis spirochetes can infect the fetus, resulting in sepsis and death of the newborn, and those who survive may also be congenital syphilis patients.
4.How to deal with TORCH screening?
The source of Toxoplasma gondii infection is animals, and the route of infection is through close contact with animals and raw meat. It is recommended to stay away from animals and pets for six months before pregnancy, and pay attention not to eat half-cooked meat and to use raw and cooked cooking utensils separately. Pre-pregnancy screening for high-temperature people with positive IgM is recommended after 3 months before pregnancy.
A negative pre-pregnancy rubella virus antibody test allows for rubella vaccination, which is 98% effective and is a lifetime immunization. You should not conceive for 3 months after vaccination and it is not necessary to retest for rubella virus-related antibodies in early pregnancy.
In our country, the adult infection rate of cytomegalovirus is over 90%. Women who are ready to get pregnant can be tested for cytomegalovirus IgG antibodies before conception, and those who are positive can be retested for related tests, and IgG can be present for life. Primary infection does not usually occur after pregnancy, but secondary infection with flu-like symptoms after pregnancy cannot be ruled out, and cytomegalovirus IgG antibody affinity index and IgM antibody tests can be performed if necessary.
Most adults in China have had herpes simplex virus – type I infection, and most women have acquired specific antibodies against herpes simplex virus, so intrauterine infections caused by this type of virus rarely occur. Therefore, pre-pregnancy testing for antibodies to herpes simplex virus can basically be disregarded at this time. If there are signs of herpes simplex virus infection in the genital tract during pregnancy, confirmed by laboratory tests, a cesarean section is recommended for delivery.
Those who test positive for antibodies to syphilis spirochetes before pregnancy need to be further diagnosed, treated promptly and cured before pregnancy. If infected in early pregnancy, they should receive regular treatment before 16 weeks of pregnancy.
Second, about female endocrine that is sex hormone six test
The six commonly used sex hormone tests are folliculopoietin (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (P), testosterone (T) and prolactin (PRL). Nowadays, many patients come to the hospital and ask for the six sex hormone tests, but the sex hormones checked at different times of menstruation have different meanings respectively, and a comprehensive and correct interpretation is needed for better disease diagnosis and treatment.
Peaks of hormone secretion.
Estrogen: 2 peaks of secretion, before ovulation and 7-8 days after ovulation, respectively;
Progesterone: 1 peak of secretion, 7-8 days before and after ovulation;
Follicle stimulating hormone (FSH): 1 peak of secretion, 24 hours before ovulation;
Luteinizing hormone (LH): 1 peak of secretion, 24 hours before ovulation.
1.Basic endocrine test time and result determination
Testing time: It is recommended to take blood test on the 2nd-5th day of menstruation, at 10-11 am, which is not related to diet and can reflect the basal state of ovaries and their reserve capacity or certain pathological states.
Result determination.
At this time, we should not look at how low E2 is to determine estrogen deficiency, but at this time E2 should be less than 50ng/L. If it is higher than this value, it indicates poor ovarian reserve, which often leads to early menstruation, once in 21-25 days;
FSH above 10IU/L also indicates poor ovarian reserve;
FSH higher than 25 IU/L is indicative of premature ovarian failure;
LH/FSH ≥2 and elevated T can assist in the diagnosis of polycystic ovaries.
A PRL >100ng/ml should be followed by magnetic resonance imaging (MRI) of the head and saddle area to exclude pituitary tumors.
Progesterone is definitely low at this time, some doctors only check 5 items of basic endocrinology without checking progesterone for this reason.
At this time, LH and FSH should be located at 3-7IU/L and the values are close to the ideal.
2.Ovulation test
The main purpose of this test is to check E, LH and P. The main purpose is to see if there is a peak of LH before ovulation and to determine whether ovulation is near or has already occurred, and to use ultrasound follicle monitoring to guide treatment.
3.Luteal Phase Examination
The best time is one week before menstruation, usually when the basal body temperature rises 6-7 days. This is the peak of estrogen and progesterone, with progesterone up to 40 nmol/L. The onset of menstruation about 7 days after the blood draw suggests accurate calculation of the time. If the peak value of progesterone is less than 15nmol/L, luteinizing insufficiency can be considered, and repeated miscarriages are more significant at this time. At this time, progesterone level <3nmol/L can determine the absence of ovulation.
Gynecological tumor marker test
Tumor markers are substances produced by tumor tissues, or secreted into blood or other body fluids, or stimulated by tumor tissues and produced by host cells with significantly higher content than normal tissues, and are closely related to the occurrence and development of tumor. There are more than 80 kinds of tumor markers found so far, and more than 30 kinds are more commonly used. At present, no tumor marker is exclusive for a certain unique tumor, but various tumors can have relatively more specific markers, which can be used to assist in diagnosis and disease monitoring.
1. Glycoconjugate antigen tumor markers.
CA125: 95% of healthy adult women have CA125 levels ≤35U/ml, 80% of ovarian epithelial cancer patients have CA125 levels higher than normal (normal value <35IU/ml), more than 90% of patients have CA125 levels consistent with disease remission or deterioration, which can be used for disease monitoring with high sensitivity, especially more specific for plasmacytoma. If there is recurrence, CA125 elevation may precede clinical symptoms; CA125 elevation is also seen in ascites caused by various malignant tumors. If examined during pelvic inflammation, menstruation, or pregnancy, CA125 may be elevated, and after these factors are removed, CA125 may return to normal; in addition, CA125 levels may also be elevated in patients with adenocarcinoma of the fallopian tube, endometrium, cervix, pancreas, intestine, breast, and lung cancer.
CA199: It can be elevated in mucinous adenocarcinoma of ovary and endometrial cancer, and is also the most sensitive marker for pancreatic cancer. CA19-9 can monitor tumor recurrence and determine prognosis, but its specificity is poor. when CA19-9 is significantly elevated, tumorigenic lesions should be considered first, but care should be taken to exclude benign lesions such as pelvic inflammatory disease.
Squamous cell carcinoma antigen (SCC)::It is a tumor marker with good specificity and is the first one used to diagnose squamous carcinoma. It has high expression in cervical and vulvar carcinoma and is related to the progression of the disease, and can be used to detect the clinical process of squamous carcinoma.
Others: CA15-3 can be elevated in gastrointestinal tract tumors and some plasma ovarian cancers, but pregnancy-induced elevation should be excluded; NB/70k can be positive in 50% of patients in early ovarian cancer and can be positive in mucinous cystic adenocarcinoma; HMFG2 has a certain positive rate in ovarian cancer and endometrial cancer; CA72-4 is one of the best tumor markers for diagnosing gastric cancer at present.
2.Embryonic and placental tumor markers.
Carcinoembryonic antigen (CEA) : It can be elevated in mucinous cystadenoma of ovary and mucinous adenocarcinoma of cervix. CEA is difficult to be detected in the blood of normal adults; 70-90% of patients with colon adenocarcinoma are highly positive for CEA.
Alpha-fetoprotein (AFP): It is a marker for ovarian endodermal sinus tumors (yolk sac tumors) and germ cell tumors containing endodermal sinus tumor components. In addition, elevated AFP is seen in patients with primary liver cancer, liver disease and pregnant women.
HCG: It is a marker for primary ovarian choriocarcinoma and mixed germ cell tumors of the ovary; in addition, it is commonly used clinically for screening of early pregnancy, ectopic pregnancy, gravida and pregnancy-related diseases.
3.Enzyme and isoenzyme tumor markers: neuron-specific enolase (NSE) can be altered in ovarian malignancies, and NSE can be elevated in both national small cell carcinoma and ovarian asexual cell tumor.
4. Hormone and hormone receptor tumor markers.
In situ hormones secreted by tumors: granulosa cell tumor and follicular membrane cell tumor can produce higher levels of estrogen, which can cause postmenopausal vaginal bleeding or precocious puberty; testicular mesenchymal cell tumor can secrete androgens
Ectopic hormones: adrenocorticotropic hormone secreted by small cell carcinoma of the cervix and erythropoietin secreted by uterine leiomyoma.
Commonly used hormone receptors are: estrogen receptor (ER) and progesterone receptor (PR), which can be used as indicators of well differentiated endometrial cancer, ovarian cancer and breast cancer that are sensitive to hormone therapy.
5.Viral markers: HPV (human papillomavirus) 16, 18, 31, 33, 35 are closely related to cervical CIN and cervical cancer.
6.Tumor-related substance markers, growth factors and genetic markers.