🦠 TORCH Infections in Pregnancy
The infections that cross the placenta and harm the fetus. What to avoid, what to screen, what to treat.
⭐ TORCH, decoded
A group of infections that cross the placenta or infect during birth, and cause congenital defects.
- T — Toxoplasmosis
- O — Other (syphilis, varicella, parvovirus B19, hepatitis B, HIV, Zika, group B strep)
- R — Rubella
- C — Cytomegalovirus
- H — Herpes simplex
The earlier in pregnancy the infection occurs, the worse the damage — because that is when organs are forming. First-trimester rubella is the classic example.
👀 Each one, and the teaching that matters
| Infection | Effect on the baby | Prevention / teaching |
|---|---|---|
| Toxoplasmosis | Hydrocephalus, intracranial calcification, chorioretinitis | Do not change cat litter. Wear gloves gardening. Cook meat thoroughly. Wash produce |
| Rubella | Deafness, cataracts, cardiac defects, intellectual disability | Vaccinate BEFORE pregnancy; live vaccine, so not during |
| CMV | Commonest congenital infection; hearing loss, microcephaly | Hand hygiene, especially around diapers and toddlers |
| Herpes (HSV) | Neonatal herpes — severe, often fatal | C-section if active lesions at delivery |
| Syphilis | Stillbirth, bone and skin lesions, deafness | Screened routinely; penicillin treats it |
| Group B strep | Neonatal sepsis, pneumonia, meningitis | Screened at 35–37 weeks; IV antibiotics in labor |
| Varicella | Limb defects, scarring; severe if near delivery | Vaccinate before pregnancy |
🚨 The rules that get tested
- Rubella and varicella vaccines are LIVE - never give during pregnancy. Give postpartum, before discharge, and advise avoiding pregnancy for 4 weeks.
- Active genital herpes lesions at the onset of labor means cesarean delivery. Vaginal birth would infect the baby.
- Pregnant women do not change cat litter. Someone else does it, or gloves and thorough handwashing.
🩺 Screening and care
✅ Routine antenatal screening
- Rubella immunity at the first visit — if not immune, vaccinate postpartum
- Hepatitis B, HIV, syphilis serology
- Group B strep swab at 35–37 weeks
- Urine culture — asymptomatic bacteriuria is treated in pregnancy
💉 Group B strep in labor
A positive swab means IV antibiotics during labor — usually penicillin, ideally at least 4 hours before delivery so levels reach the baby.
GBS is normal flora in the mother and harmless to her. The risk is entirely to the newborn.
👶 Signs of neonatal infection
Newborns show infection non-specifically — often without fever:
- Temperature instability — low as often as high
- Poor feeding, lethargy, irritability
- Respiratory distress, grunting, apnea
- Hypoglycemia, jaundice appearing early
A newborn who is simply "not feeding well and floppy" may be septic. Absence of fever means nothing at this age.
🎯 NCLEX traps
- No cat litter — toxoplasmosis
- Rubella vaccine postpartum, never during pregnancy
- Active herpes lesions = cesarean
- GBS swab at 35–37 weeks, IV antibiotics in labor
- Earlier infection = worse damage