Many expectant mothers may not know what “TORCH” is, but they certainly often hear doctors and other expectant mothers talk about the so-called “Eugenics 4” and “Eugenics 5” tests. This test sounds very important. This test sounds very important, and the consequences of not doing it can be scary, but once you do it, you will be caught in a big choice trap that will leave you in a dilemma. There are so many conflicting interpretations of so-called “positive” results on the internet that even obstetricians are often unsure, and even when they find a real expert, they can only shake their heads and give a vague, uncertain answer after reading all the reports. I am that specialist who often gives you a vague answer while shaking my head and sighing. As to why, please let me try to give you a reasonable explanation, not sure if I can really put this troublesome matter into perspective. What is a “TORCH” infection? The term “TORCH” was first coined by Andre Nahmias in the 1970’s to refer to a group of pathogenic microorganisms that cause fetal malformations and dysfunction when contracted during pregnancy. The “T” refers to Toxoplasmosis, the “O” refers to Other pathogenic microorganisms, the “R” refers to Rubella, and the “D” refers to Rubella. Rubella”, “C” refers to Cytomegalovirus and “H” refers to Herpes simplex virus. “What does TORCH infection mean? “The common feature of TORCH infection is that it is transmitted vertically from mother to child and may cause intrauterine infections, resulting in miscarriage, preterm labor, stillbirth, fetal abnormalities, and neonatal infections, which are usually asymptomatic or mild in pregnant women. For mothers: TORCH infections are not taken seriously because they are not serious; they are not easily diagnosed because there are no specific clinical manifestations of TORCH infections. For fetuses and newborns: the consequences of TORCH infection can be mild or severe, and therefore interpretation is confusing. In the case of TORCH infection in pregnant women, we need to remember the principle that infection of the mother does not necessarily lead to intrauterine infection of the fetus, and fetal infection does not necessarily have serious consequences. Indicators that should be included in TORCH screening Indirect indicators: mainly IgG and IgM antibodies, which are indicators of the immune response produced by the body after infection with pathogens and are related to the individual’s immune function, and are mainly used for screening for infections and assessment of immune status. IgG antibody: indicates previous infection, if IgG antibody (+), it indicates immunity. IgM antibody: if IgM antibody (+), it generally indicates recent infection, but in some cases, IgM antibody can persist for a long period of time, so IgM antibody (+) cannot simply be equated with recent infection. IgG affinity: IgG affinity can help us to confirm the duration of the pathogen’s infection. Generally speaking, a high IgG affinity indicates a distant infection, while a low affinity indicates a recent infection. Antibody quantitative examination: Simple antibody qualitative examination can not help us to determine whether the infection is recent or distant, it can help to determine the change of titer level by antibody quantitative examination in different time periods. Direct Indicator: It is mainly used to examine the pathogen itself using molecular diagnostic methods (e.g., PCR), and is used to confirm the diagnosis of TORCH infection. Purpose of TORCH screening TORCH screening can be performed at different times. Pre-pregnancy screening can help us assess immunity and find out which are the high-risk groups that are prone to problems after pregnancy; post-pregnancy screening can determine the status of the infection and make prenatal diagnosis accordingly; and screening of newborns can provide a diagnosis of postnatal congenital infections. The current situation of TORCH screening in China Emphasis on screening, not on diagnosis: TORCH screening is widely practiced in China, even in very small grass-roots hospitals in the name of “eugenics”. Many tests and reagents are used, and many of them only use ELISA to do qualitative tests, resulting in a high false-positive rate and bringing a lot of unnecessary trouble. There are many hospitals that conduct screening tests, but very few hospitals conduct confirmatory tests. In order to further confirm the presence of recent intrauterine infections and fetal anomalies, IgG affinity tests are required, amniocentesis for PCR of pathogens, and detailed fetal ultrasound structures. These techniques are either too complicated, do not have Chinese “FDA” license, or do not have a fee schedule, and are complicated and risky to perform, and cannot be charged for, thus leading to the chaos of everyone rushing to do the screening, but no one to do the diagnosis. It is irresponsible to allow pregnant women to undergo abortion or induce labor based on the results of screening tests that have a high false-positive rate without confirmatory testing. Lack of multidisciplinary cooperation: Screening and diagnosis of TORCH infection is not only the work 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 for high-risk newborns. Therefore, after so many years of TORCH screening in China, we are still unable to draw a reliable clinical conclusion in China with evidence-based medical evidence and responsible clinical counseling for patients, and the data we use are still foreign data, which is obviously inappropriate. Chaos in TORCH screening and diagnosis Chaos 1: High false-positive rate As mentioned earlier, what many hospitals use is a simple qualitative test, which leads to a high false-positive rate, and some doctors over-interpret it and recommend termination of pregnancy without doing a confirmatory test. Confusion 2: Doing it at the wrong time The principle of managing birth defects is three-tiered prevention, preferably primary prevention, that is, TORCH screening before pregnancy to determine a woman’s immune status and to identify high-risk groups. This is followed by secondary prevention, which is TORCH screening and necessary prenatal diagnosis after pregnancy. Then comes tertiary prevention, which is TORCH screening of newborns for early detection and intervention. Nowadays, it’s common for people to get TORCH screening after pregnancy, and only after they’ve entered the mid-pregnancy period, making it impossible for doctors to accurately determine the time frame of the infection, which makes interpreting the results difficult. Confusion #3: Inability to do confirmatory tests or exams In China, where TORCH screening is common, it’s surprising that many of the reagents and methods used to help conduct confirmatory tests for TORCH infection have not yet been approved by China’s FDA or are not available for a fee. This is a big joke, and the root cause of why even the experts can’t do anything about it. In addition, the phenotype of abnormalities caused by TORCH infection is also difficult to be diagnosed in utero, such as deafness and intellectual effects, which cannot be detected by ultrasound, which is also one of the helplessness of clinicians. Confusion 4: Outrageous interpretations Most clinicians lack a systematic and 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, and information and results from pandemic periods of the pathogen are applied to non-pandemic periods. For example, the mutation of the rubella virus with a significant increase in virulence can lead to a pandemic of rubella virus infection, which can result in a relatively high incidence of fetal birth defects. Rubella virus infection during a non-pandemic period does not necessarily result in such severe harm, and it is clearly inappropriate to apply information from a pandemic period to a non-pandemic period. Recommendations for TORCH screening and diagnosis: 1. It is not routinely recommended for everyone, and screening and diagnosis are recommended for those at high risk. 2, Screening is recommended before pregnancy and at the appropriate gestational week (according to the appropriate guidelines). 3.Screening in institutions capable of further diagnosis (No Diagnosis, No Screening), if the institution carrying out screening does not have further diagnostic capacity, a reasonable referral mechanism must be established with institutions capable of diagnosis. 4, recommended quantitative testing methods, recommended to determine the affinity of IgG antibodies. 5. Diagnostic centers should have the following capabilities: the ability to perform amniocentesis and use molecular diagnostic techniques to confirm pathogenic microorganisms, the ability to perform targeted and detailed ultrasound examinations of fetal structures, the ability to provide multidisciplinary consultations, and the ability to systematically follow up high-risk newborns over a long period of time.