OB: Infections "TORCH"
What does TORCH stand for?
Toxoplasmosis Other (T. palladium, Varicella-zoster virus, Parvovirus B19, Hepatitis) Rubella virus Cytomegalovirus (CMV) Herpes Simplex Virus (HSV)
How do you treat infants with VZV?
VZIG
What do you give immunocompromised children and adult with VZV?
VZV immunoglobulin (VZIG) to decrease severity and complications; can try antivirals (Acyclovir and Vlaacyclovir)
How do you confirm toxoplasmosis in utero?
amniocentesis to obtain fluid
What can parvovirus cause?
anemia
What does CRS commonly cause?
cataracts, cardiac defects, deafness, glaucoma, microcephaly, CNS defects
What is CVS associated with?
cataracts, chorioretinitis, limb hypoplasia, hydronephrosis, microcephaly, mental retardation, dermatome lesion and cutaneous scars
What can happen if mother contracts rubella prior to 8th week of pregnancy? after 20th week?
congenital rubella syndrome (CRS); rarely causes defects
What population is CMV most common in?
day cares and groups of young children
How is CMV transmitted?
direct contact with infected body fluid
What can happen if a patient gets severe anemia from parvovirus?
hospitalization and blood transfusion
How do you treat HIV or immunocompromised patients with Parvovirus?
immunoglobulins
What are the characteristics of a varicella-zoster virus (VZV) rash?
maculo papular/vesicular lesion that open then crust. highly pruritic
What can listeriosis result in for the newborn?
meningitis and encephalitis
What can happen if exposed to toxoplasmosis in early pregnancy?
miscarriage
What is an issue of CMV in pregnancy?
no treatments that are safe
What are neonatal complication of toxoplasmosis?
obstructive hydrocephalus and intracranial calcifications associated with mental retardation, seizure activity and motor & developmental delays can occur. chorioretinitis can lead to blindness
When can varicella be passed to the newborn from mom?
6 days prior to 2 days after birth
What patients with toxoplasmosis do you treat?
pregnant/immune compromised patients NO NEED to treat healthy individuals
How is toxoplasmosis spread?
protozoan spread by contact w/ infected raw meat or cat feces
How is parvovirus diagnosed?
seeing the facial and truncal rash on exam or Parvovirus IgM to confirm
What can happen if listeriosis infection occurs in first trimester?
spontaneous abortion
What can happen if patient has rubella early in her pregnancy?
still birth, miscarriage, fetal anomalies
What are other s/s of rubella?
temperature >99, arthralgia or arthritis, lymphadenopathy or conjunctivitis
What can fear of fetal anomalies lead to?
termination
How would you describe VZV lesions?
they appear in 2-4 groups or "crops" on mucous membranes of oropharynx, respiratory tract, vagina, conjunctiva and cornea
Patient education issues with TORCH
Be sure pt is clear about WHICH infection she/baby are being treated for Etiology and course of infection How to take Rx meds S/e if any rx meds Fetal/neonate effects of the disease Timing and purpose of any extra screenings for fetus If screening of some of the disease is done prenatally, be sure pt knows her risk status For diseases which she is "at risk" teach preventative measures for the safety of the pregnancy
Prior to 20 week, the fetus can develop what?
Congenital Varicella Syndrome (CVS)
What is the most common cause of congenital infection in US?
Cytomegalovirus (CMV)
What should you do to non-immune women prior to pregnancy?
vaccinate!
What are the s/s of toxoplasmosis?
vague, like mono and in most cases pt is asymptomatic
What else should you consider?
HIV
How do you prevent CMV?
Hand washing Avoid kissing children under age 6 on the mouth Don't share food, drinks, utensils with young children
What problems can appear in newborns?
Hearing, vision loss Mental disability Lung problems Spleen, liver and bleeding problems Growth problems
What do infants with CRS frequently exhibit?
IUGR and post-natal growth restriction
How do you treat the mother for listeriosis?
IV or IM antibiotics (ampicillin, PCN or erythromycin usually prevents fetal infection)
What causes slapped cheek disease or fifth disease?
Parovirus
What is an acute onset of generalized macula-papular rash a symptom of?
Rubella
When is the greatest risk of congenital varicella in pregnant women?
20 weeks