Obstetrics [PRENATAL INFECTIONS 2]

TORCH: Toxoplasmosis
Toxoplasmosis is a parasite (T. gondii) that’s transmitted through
cat feces, contact with cysts in soil, or eating undercooked meat.
Mom will experience a mono-like syndrome (fever, malaise,
hepatosplenomegaly, cervical lymphadenopathy). If infected,
mom can transmit the bug to baby. It’s often only devastating in
the 1st trimester, which will provoke brain calcifications,
ventriculomegaly, and seizures. More common (though less
often tested) are hearing loss, visual disturbances, and
development delay. If mom’s ever been exposed prior to
pregnancy (toxo ab positive), she’ll be immune - baby will not be
at risk. Toxo antibodies are often part of trimester 1 labs.

TORCH: Other (Syphilis)

Every mom gets screened for syphilis every pregnancy. We talk Primary Secondary Late Latent Tertiary
a lot about syphilis in the ID – genital ulcer lectures, so here we Painless Fever, Rash Positive Neuro sxs
focus on what happens to baby if not treated. If mom gets infected Chancre Targetoid serology tabes dorsalis
with syphilis in the first trimester, baby won't survive and will Palms, Sole without sxs AR Pupils
present as a dead and macerated fetus. Signs of congenital Dark field RPR (1st) RPR (1st) Lumbar Puncture
syphilis (those who live) are saddle nose, saber shins, and Microscopy FTA-Abs FTA-Abs
Hutchinson’s teeth along with snuffles (nasal discharge), Penicillin Penicillin Late Latent: Penicillin IV q4h
generalized lymphadenopathy, and hepatosplenomegaly. IM x one IM x one Penicillin for 2 weeks
Treating mom with penicillin can prevent all the damage. The IM q wk x 3
treatment’s always penicillin. If she is penicillin allergic, Early Latent treatment = Secondary, Late latent = “Latent”
desensitize. If Penicillin allergic USE PENICILLIN ANYWAY

TORCH: Rubella (German Measles)

German measles is transmitted by respiratory droplets. It can pass Congenital Rubella Syndromes
to baby during a primary viremia - mom must be unvaccinated “Blueberry Muffin Baby” Cdeafness
and exposed for the first time while pregnant to be a problem. Petechiae and Purpura in Cataracts
Rubella can be vaccinated against using the MMRV vaccines. 3rd trimester Congenital Heart Defects
Because it’s a live attenuated virus, receiving the vaccine while IUGR (1st trimester)
pregnant will induce viremia and potentially cause harm to baby. Abortion (1st trimester)
Mom should get a vaccine at least 3 months prior to pregnancy;
she will also need to be isolated from children who are
unvaccinated (those too young for the vaccine or antiscience
Californians).
CMV
TORCH: Cytomegalovirus (CMV) Mom Baby
The least sexy of the TORCH infections, also the least likely to Vague viral illness or Jaundice, petechial, low
be tested. It’s double-stranded DNA virus spread by all body completely asymptomatic platelets, IUGR, hearing
fluids. We don’t usually test for it. There’s nothing to do about it. loss hepatosplenomegaly
It’s generally asymptomatic; we treat supportively. There’s no
vaccination for it either. Dedicate the least time to this one. The most vague and incomplete syndromes ever. If it
sounds like mono but isn’t, and it’s not Toxo, it’s CMV.
TORCH: Herpes (HSV) = Genital Herpes
HSV1 or 2 can be genital. Primary viremia (first exposure) does
the most harm as it can cross the placenta. Reactivation of herpes Primary Secondary Congenital
doesn’t cross, but active lesions can infect baby at delivery. First exposure Reactivation IUGR
Lesions will be preceded by a painful, burning prodrome. Crosses Placenta No cross Preterm Birth
Vesicles on an erythematous base describes the lesions. To placenta
confirm, use PCR of active lesions; the Tzanck prep is always Congenital Infectious risk Blindness
wrong. If mom has active lesions, perform C-section to avoid (Val)acyclovir (Val)acyclovir
fetal exposure. Treat primary and secondary outbreaks with C-Section C-Section
antivirals. Prophylaxis with acyclovir from week 36 to delivery
to make sure there aren’t active lesions at delivery. Varicella (Shingles/Chickenpox) is another Herpes species.
Get mom the MMRV vaccines before conceiving!

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