Many mothers-to-be may not be sure what “TORCH” is, but they certainly hear doctors and other mothers-to-be talk about the so-called “Eugenics 4” and “Eugenics 5”. The test sounds important. This test sounds very important, and the consequences of not doing it seem terrible, but once you do it, you will be caught in a big choice trap, leaving you with a dilemma. Even if you find a real specialist, after reading all the reports, you can only shake your head and give a vague and uncertain answer. I am the specialist who often shakes his head and sighs while giving you a vague answer, so let me try to give you a reasonable explanation as to why, and I don’t know if I can really explain this trouble thoroughly. What is a “TORCH” infection? The term “TORCH” was first coined by AndreNahmias in the 1970s to refer to a group of pathogenic microorganisms that cause fetal malformations and dysfunctions when contracted during pregnancy. The “T” refers to Toxoplasmosis, the “O” refers to Others, the “R” refers to Rubella, and the “C” refers to the “C” refers to the “R”. Rubella, “C” refers to Cytomegalovirus, and “H” refers to Herpes simplex virus. What does “TORCH” infection mean? “TORCH infection is characterized by vertical transmission from mother to child, which can lead to intrauterine infection, miscarriage, premature birth, stillbirth, fetal malformation and neonatal infection. For the mother: TORCH infection is not taken seriously because its effects are not serious; it is not easily diagnosed because there are no specific clinical signs of TORCH infection. For the fetus and newborn: the consequences of TORCH infection can be mild or severe, so the interpretation is confusing. In the case of TORCH infection in pregnant women, it is important to remember that infection in the mother does not necessarily lead to intrauterine infection in the fetus and that infection in the fetus does not necessarily lead to serious consequences. Indirect indicators: These are mainly IgG and IgM antibodies, which are indicators of the immune response of the body to pathogenic infections and are related to the immune function of the individual, and are mainly used for screening of infections and assessment of immune status. IgG antibodies: indicate previous infections, and if IgG antibodies (+), immunity is indicated. IgM antibody: If it is IgM antibody (+), it generally indicates a recent infection, but in some cases, IgM antibody persists for a long time, so IgM antibody (+) does not simply equate to a recent infection. IgG affinity: IgG affinity can help us to confirm the duration of pathogen infection. Generally, a high IgG affinity indicates a distant infection and a low affinity indicates a recent infection. Quantitative antibody tests: Simple qualitative antibody tests cannot help us determine whether the infection is recent or distant. Quantitative antibody tests at different time periods can help determine this based on changes in titer levels. Direct indicators: mainly molecular diagnostic methods (e.g. PCR) are used to examine the pathogen itself and are used for the confirmatory diagnosis of TORCH infection. Purpose of TORCH screening TORCH screening can be performed at different times. Screening before pregnancy can help us assess immunity and find out which are the high-risk groups that are prone to problems after pregnancy; screening after pregnancy can determine the status of the infection and make the corresponding prenatal diagnosis; screening of newborns can provide the diagnosis of congenital infection after delivery. The current situation of TORCH screening in China Emphasis on screening, light on diagnosis: TORCH screening is commonly carried out in China, even in very small and grassroots hospitals in the name of “eugenics”. There are many different tests and reagents used, many of which are only qualitative tests using ELISA, resulting in a high false positive rate and many unnecessary problems. There are many hospitals that conduct screening tests, but few hospitals conduct confirmatory tests. To further confirm the diagnosis of recent intrauterine infection and fetal abnormalities, IgG affinity testing, PCR for pathogens by amniocentesis, and detailed examination of fetal ultrasound structures are required. These techniques are either too complicated, or there is no Chinese “FDA” license, or there is no fee schedule, so they are complicated and risky to perform, and no fee can be charged, so it leads to the chaotic situation that people rush to do screening, but no one does diagnosis. It is irresponsible to let pregnant women have abortions or induce abortions based on screening results with high false positive rates without confirmatory tests. Lack of multidisciplinary cooperation: The screening and diagnosis of TORCH infection is not only the responsibility of obstetricians, but also requires multidisciplinary cooperation and follow-up by ultrasonographers, laboratories, neonatologists, and pediatricians. The current situation in China is that there is little communication between the various disciplines, and there is a lack of systematic screening and follow-up of high-risk newborns. Therefore, after so many years of TORCH screening in China, we are still unable to draw a reliable clinical conclusion with evidence-based medical evidence for China and responsible clinical counseling of patients, and the data we use are still foreign data, which is clearly inappropriate. Confusion in TORCH screening and diagnosis Confusion 1: High rate of false positives As mentioned earlier, the simple qualitative test used by many hospitals leads to a high rate of false positives, and some doctors overinterpret it and recommend termination of pregnancy without doing a confirmatory test. Confusion II: Wrong time to do it The management of birth defects is based on the principle of tertiary prevention, preferably primary prevention, that is, TORCH screening before conception to determine the immune status of women and to detect high-risk groups. This is followed by secondary prevention, which is TORCH screening and necessary prenatal diagnosis after pregnancy. Then there is tertiary prevention, which is TORCH screening of newborns for early detection and intervention. Nowadays, it is common for people to have TORCH screening after pregnancy and only after they reach the middle of pregnancy, making it impossible for doctors to accurately determine the time period of the infection, which makes the interpretation of the results difficult. Confusion 3: No confirmatory tests or examinations are available In China, where TORCH screening is commonly performed, many of the reagents and methods used to help perform confirmatory tests for TORCH infection have actually not yet been approved by the Chinese FDA or are not available for a fee. This is a big joke and the fundamental reason why even the experts can’t do anything about it. Also, the phenotype of abnormalities caused by TORCH infection is difficult to diagnose in utero, such as deafness and intellectual effects, which cannot be detected with ultrasound, and this is one of the clinicians’ helplessness. Confusion 4: Interpretation is off the mark Most clinicians lack a systematic scientific understanding of the consequences, screening and diagnosis of TORCH infection. The consequences of TORCH infection are exaggerated to varying degrees in both textbooks and the literature, applying information and results from the pathogenic pandemic period to the non-pandemic period. For example, the mutation of the rubella virus, which is significantly more virulent, leads to a pandemic of rubella virus infection, which results in a higher incidence of fetal birth defects. In contrast, rubella virus infection during non-pandemic periods does not necessarily lead to such severe harm, and it is clearly inappropriate to apply information from pandemic periods to non-pandemic periods. Recommendations for TORCH screening and diagnosis: 1. It is not routinely recommended for everyone, and screening and diagnosis is recommended for high-risk groups. 2.It is recommended to be screened before pregnancy, at the appropriate gestational week (according to the appropriate guidelines). 3.Screening should be done at an institution capable of further diagnosis (No Diagnosis, No Screening). If the institution conducting the screening does not have further diagnostic capability, a reasonable referral mechanism must be established with an institution capable of making diagnosis. 4.The quantitative test method is recommended, and the affinity of IgG antibody is recommended to be measured. 5. The diagnostic center should have the following capabilities: it can perform amniocentesis and use molecular diagnostic techniques to confirm pathogenic microorganisms, it can have the ability to perform targeted and detailed ultrasound examination of fetal structures, it can provide multidisciplinary consultation, and it has the ability to provide systematic and prolonged follow-up of high-risk newborns.