The beginning of a new life is a joyous event for every couple, but in addition to the joy of the little life in the womb of the mother-to-be, there is also some apprehension and anxiety, worrying about whether the baby will have any problems? Is it healthy? These worries are normal because the early stage of pregnancy (first trimester) is the period of fetal organ formation and is susceptible to external environmental factors such as drugs, X-rays and viral infections that can cause embryonic developmental disorders. Among them, the impact of TORCH intrauterine infection on the fetus is gaining high attention. In order to take effective preventive and control measures against viral infections in early pregnancy to reduce the birth of sick and disabled children, the TORCH test can be performed in early pregnancy as part of the “Eugenics 5” test, which is a routine pregnancy test in many regions. The TORCH test usually refers to serum antibody testing for toxoplasma, rubella virus, cytomegalovirus, and herpes simplex virus types I and II. TORCH is an abbreviation for a group of pathogenic microorganisms. 1971 Nahmias et al. put together several infectious diseases in pregnant women that can cause fetal infections and even congenital malformations or developmental abnormalities, using the first combination of five words to form the term TORCH, which is called TORCH perinatal complex infection, or TORCH infection. T refers to toxoplasma (TOX), O refers to other pathogenic microorganisms (others, mainly syphilis, Listeria monocytogenes, etc.), R refers to rubella virus (RV), C refers to cytomegalo virus (CMV), and H refers to herpes simplex virus (HSV). Herpes simplex virus (HSV) type I and type II. I. How TORCH infection affects the fetus 1. Toxoplasma gondii: Toxoplasma gondii infection is a zoonotic disease that is widely distributed around the world. It is more likely to be transmitted from cats and other pets to humans. When the body’s immune function is low, heavy cases can cause various symptoms, such as high fever, muscle and joint pain, and swollen lymph nodes. In the first infection during pregnancy, Toxoplasma gondii can infect the fetus through the placenta, and in early pregnancy, it can cause miscarriage, stillbirth and embryonic developmental disorders; in the middle and late pregnancy, it can cause intrauterine fetal growth retardation and a series of central nervous system damage (such as anencephaly, hydrocephalus, microcephaly, mental retardation, etc.), eye damage (such as anophthalmia, monocularity, small eyes, etc.) and congenital damage to internal organs (such as esophageal atresia). etc., seriously threatening the health of the fetus. 2, rubella virus: pregnant mothers infected with rubella virus (generally through the inhalation tract infection), after 14 to 21 days of incubation period, will appear low fever, runny nose, rash and other symptoms, of course, some pregnant mothers do not have any clinical manifestations (known as latent infection). The virus can cause infection in the fetal baby through the placenta and can lead to congenital rubella syndrome in the baby, resulting in congenital cataracts, heart disease, deafness and other permanent developmental malformations after birth. In the first month of pregnancy, the mother is infected with rubella virus, the fetal baby infection rate reaches 50%; in the second month of pregnancy, the fetal baby infection rate reaches 30%; in the third month of pregnancy, up to 20%; after the fourth month of pregnancy, less than 5%. Cytomegalovirus: Cytomegalovirus infection is contracted by pregnant mothers from infected patients or virus carriers through kissing and sexual intercourse. Most pregnant mothers do not show symptoms, a few have fever and swollen lymph nodes. Infection of the fetal baby is highest during early pregnancy (within 3 months) and does not usually cause infection of the fetal baby in the second trimester. The most immediate consequence of an infected fetal baby is damage to the central nervous system and liver. For example, hydrocephalus, cerebral softening, motor nerve disorders, hearing impairment, loss, and chronic hepatitis. Most affected children die within hours or weeks after birth, with a mortality rate of 50% to 70%. Because the cervix can discharge cytomegalovirus, pregnant mothers may also be transmitted to the fetal baby via the birth canal during delivery. 4, herpes simplex virus: herpes simplex virus is divided into two types HSV-Ⅰ and HSV-Ⅱ. Herpes simplex virus infection mainly causes herpes stomatitis, herpes keratoconjunctivitis, herpes meningitis, herpes vulva guidingitis, wet diagnosis herpes, neonatal herpes, etc. HSV infection in early pregnancy can destroy the germ and lead to miscarriage, while infection in the middle and late pregnancy can cause fetal and neonatal morbidity, although malformations are rare. If a fetal baby is infected, a few babies will be born with symptoms such as skin herpes, squinting eyes, blindness, deafness, hydrocephalus, and intracranial calcification. Fortunately, these changes are extremely rare, so experts believe that even if a mother becomes infected with herpes simplex virus in early pregnancy, there is usually no need to terminate the pregnancy. Only if the mother becomes ill within a short period of time before delivery can she transmit the virus to her baby because no antibodies have been developed. Once a newborn is infected with the herpes simplex virus, the prognosis is very poor, with about half of the newborns dying and most of the other half also having central nervous system sequelae. Second, what is the significance of TORCH testing Pregnant women who are infected with TORCH have mild symptoms or even no obvious signs and symptoms, but these pathogens can be transmitted vertically through the placenta, leading to embryonic arrest, miscarriage, stillbirth, premature birth, congenital malformations, and even affect the baby’s intellectual development after birth, causing lifelong sequelae. Therefore, preconception and early pregnancy diagnosis is very important for eugenics. Currently, the most convenient and advanced early diagnosis method recognized internationally is to detect specific IgM and IgG antibodies in human serum to determine the situation of being infected. Many developed countries around the world have included TORCH as a routine screening test during pregnancy, which plays an important role in eugenics. In China, with the development of science and technology and the improvement of people’s living standards, people’s awareness of eugenics has gradually increased, and TORCH testing has received more and more attention. Third, how to read the TORCH serological test report TORCH infection, the patient-specific antibodies IgM, IgG can be rapidly increased, IgM appears early can last 6 to 12 weeks, while IgG appears late but can be maintained for life. Therefore, we often regard IgG positivity as a previous infection, while IgM positivity is used as a diagnostic indicator for the first infection. 1.IgG positive, IgM negative: It generally indicates that the pregnant woman has been infected with this virus before, or has been vaccinated and has developed immunity, and it is very unlikely that the fetus will be infected. However, if the cytomegalovirus serum IgG is positive, the virus may still exist. 2.IgG negative, IgM negative: indicates that the pregnant woman is a susceptible person. It is best to repeat the IgG test during pregnancy to see if there is a positive shift. 3.IgG negative, IgM positive: indicates that the pregnant woman has been infected recently, or is in the “window period” of acute infection; it may also be caused by other interfering factors (such as rheumatic or rheumatoid arthritis, autoimmune diseases, etc.). If the IgG is positive, it is an acute infection, otherwise it is judged as false positive. 4.IgG positive and IgM positive: It indicates that the pregnant woman may have primary infection or re-infection. Can be identified by IgG affinity test. Since maternal TORCH infection does not mean that intrauterine infection has also occurred in the fetus, it is prudent to treat TORCH IgM positive patients with clinical symptoms as follows: (1) ask them to retest the second blood sample in two weeks, preferably with different manufacturers’ reagents at the same time; (2) recommend to go to a higher hospital for confirmatory tests; (3) conduct dynamic observation of antibody levels (3) Monitor the development trend of the disease. The treatment of primary TORCH infection during pregnancy must be cautious, otherwise it will bring great physical and psychological harm to the pregnant woman. 1. Early pregnancy should be actively tested for Toxoplasma gondii antibodies, and those with acute infection should be treated with antihelminthic therapy as soon as possible according to medical advice. For early and mid-term pregnancies (within 24 weeks), pregnant women with positive Toxoplasma gondii antibodies should be aborted or given medication to reduce the occurrence of intrauterine fetal infection. 2, rubella virus infection is one of the main causes of birth defects in babies. If you are infected with rubella in early pregnancy (positive serum IgM antibodies), the possibility of malformed development of the fetal baby is high, and the mother should terminate the pregnancy. If the infection occurs in the middle or late stages of pregnancy, prenatal diagnosis should be performed to rule out infection in the fetus before continuing the pregnancy. The mother should also be careful with the medication, mainly symptomatic treatment, and pay attention to avoid damage to the fetus. If the serum cytomegalovirus antibody is positive for IgM or IgG, it means that the pregnant mother is infected. Generally, if the infection is early in pregnancy, the pregnancy can be terminated immediately or wait until 20-24 weeks of gestation for cord blood IgM antibody, cord blood and amniotic fluid pathogen DNA test to find out whether the baby is congenitally infected. If the infection is confirmed, the pregnancy should be terminated at the appropriate time. The majority of cytomegalovirus infections in pregnant mothers are subclinical and generally do not require special treatment. Even if intrauterine cytomegalovirus infection is detected prenatally, drug treatment is not recommended because it does not change the condition of the baby. Anti-viral treatment (which only works to treat the pregnant mother) is only considered if she is immunocompromised and shows symptoms of cytomegalovirus overt infection. 4, serum herpes simplex virus IgM antibody positive, available clearing and detoxifying herbs (such as Pancreatin) to inhibit the proliferation of the virus and control the infection, the lesions are coated with 1% gentian violet to keep dry. Since the chance of the fetus being affected is small, it is usually not necessary to terminate the pregnancy. In principle, cesarean delivery is performed during delivery. Even if the lesion is cured, cesarean delivery is still preferable if the first infection is less than one month old. V. How to prevent TORCH infection Although these viruses can have adverse effects on the mother and baby, they can be prevented: 1. Toxoplasma gondii: stay away from cats and other pets; pay attention to dietary hygiene and do not eat raw or undercooked meat to prevent infection with Toxoplasma gondii; there are various easy and effective medications for Toxoplasma gondii infection, such as sulfonamide plus ethidium, and spiramycin, etc. Treatment should be carried out according to medical prescription. The timely treatment of infection in pregnant women can reduce the chance of fetal infection. 2, rubella virus: China’s official clinical application of live attenuated rubella vaccine from the 1990s has significantly improved the immunity of women of childbearing age, thereby reducing rubella infection during pregnancy. Women who test negative for serum IgG antibodies before marriage should be vaccinated, but be careful to use contraception within three months after vaccination. In early pregnancy, pregnant mothers should go to public places as little as possible to avoid contact with rubella patients. 3, cytomegalovirus: Do not come into close contact with the patient, and their detoxification products should be disinfected in a timely manner. 4, herpes simplex virus infection: there is no specific prevention method. In recent years, it has been reported that: daily oral acyclic guanosine can prevent recurrence in adults; for newborn babies delivered by mothers with genital herpes, prophylactic static acyclic guanosine can be given for 5 consecutive days, safe and without serious adverse effects.