What is TORCH infection

TORCH infection is short for Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections. TORCH infections are some of the most common infections in pregnancy and are associated with birth defects. Most of the TORCH infections cause mild maternal morbidity, but have serious fetal consequences, and treatment of maternal infection frequently has no impact on fetal outcome. Therefore, recognition of maternal disease and fetal monitoring once disease is recognized are important for all pregnant women. Knowledge of these TORCH infection diseases will help pregnant women on preventive measures to avoid these infections.

The TORCH panel is a group of blood tests that detect the presence of antibodies produced by the immune system in response to these TORCH infections. Confirmation of an active TORCH infection may require more specific tests.

TORCH infection in pregnancy

Toxoplasmosis

Toxoplasmosis is a parasitic infection caused by a parasite called Toxoplasma gondii, that can be passed from mother to baby through the placenta during pregnancy. An infection with Toxoplasma gondii can cause eye and central nervous system infections as well as brain and muscle cysts. If acquired during the pregnancy, it may result in a miscarriage or cause birth defects, though this depends on the time during the pregnancy when the infection was acquired by the mother. Toxoplasmosis is acquired by ingesting the parasite when handling the stool of infected cats, drinking unpasteurized goat’s milk, and, most commonly, by eating contaminated meat. The Toxoplasma gondii parasite is so tiny you can’t see it.

More than 60 million people in the United States may have the Toxoplasma gondii parasite. Very few people have symptoms because a healthy immune system usually keeps the Toxoplasma gondii parasite from causing infection. But toxoplasmosis can cause big health problems for your baby during pregnancy.

How do I get infected with toxoplasmosis?

You can come in contact with the parasite that causes the infection through:

• Eating raw or undercooked meat
• Eating unwashed fruits and vegetables
• Touching cat poop
• Touching kitchen utensils and cutting boards used to prepare raw or undercooked meat and fruits and vegetables
• Touching dirt or sand

How do I know if I have toxoplasmosis?

You may not know if you have the Toxoplasma gondii parasite infection. Lots of times there are no symptoms. For some people, it feels like the flu. Symptoms can include:

• Achy muscles
• Headache
• Fatigue (tiredness)
• Fever
• Discomfort
• Swollen glands

These symptoms can last for a month or longer. If you think you have toxoplasmosis, talk to your health care provider. Your provider can give you a blood test to find out if you have the infection. Even though blood tests are a regular part of prenatal care, you don’t’ usually get testing for toxoplasmosis. So be sure to talk to your provider if you think you have the infection.

Can toxoplasmosis cause problems before pregnancy?

If you have toxoplasmosis within 6 months of getting pregnant, you may be able to pass it to your baby during pregnancy. Talk to your health care provider about being tested.

Can toxoplasmosis cause complications during pregnancy?

Yes. Pregnancy complications caused by toxoplasmosis include:

• Preterm birth – Birth before 37 weeks of pregnancy
• Stillbirth – This is when a baby dies in the womb after 20 weeks of pregnancy

If you get toxoplasmosis during pregnancy, you have a 3 in 10 chance (30 percent) of passing the infection to your baby. The later in your pregnancy you get infected, the more likely it is that your baby gets infected. But the earlier in pregnancy you get infected, the more serious the baby’s problems may be after birth. For example, he could have microcephaly or vision problems. Some infected babies may die.

If you have toxoplasmosis during pregnancy, your health care provider may suggest a test called amniocentesis (also called amnio) to see if your baby is infected. Amnio is a test that takes some amniotic fluid from around your baby in the uterus. You can get this test at 15 to 20 weeks of pregnancy.

The fluid can be tested to see if your baby has toxoplasmosis. It also can be tested for other problems with the baby, like birth defects or genetic problems. Birth defects are problems with a baby’s body that are present at birth. Genetic conditions may be passed from parents to children through genes and include certain diseases and birth defects.

Can toxoplasmosis during pregnancy harm my baby?

Most babies born with toxoplasmosis have no symptoms. But about 1 in 10 babies (10 percent) with the Toxoplasma gondii parasite infection are born with problems, including:

• Eye infections
• Enlarged liver and spleen
• Jaundice (yellowing of the skin and the whites of the eyes)
• Pneumonia

Without treatment, 8 or 9 out of 10 newborns (85 percent) may develop problems later in life, even if they show no symptoms earlier. These problems include:

• Intellectual disabilities
• Vision problems
• Cerebral palsy (a group of disorders that can cause problems with brain development that can affect a person’s balance, posture and ability to move)
• Seizures
• Hearing loss

Each year, between 400 and 4,000 babies in the United States are born with toxoplasmosis. If you think you had toxoplasmosis during pregnancy, be sure your baby is tested. Your baby can have a blood test to check for this infection.

How is toxoplasmosis treated during pregnancy?

Getting treatment with certain antibiotics helps reduce the chance of your baby getting toxoplasmosis. Antibiotics are medicines that kill some types of organisms that cause infections. This treatment also helps reduce the seriousness of any symptoms your baby may have.

If you’re infected before 18 weeks of pregnancy, your provider may give you an antibiotic called spiramycin. This medicine helps reduce the chance of your baby getting the infection.

If you’re infected after 18 weeks of pregnancy, your provider may give you different antibiotics called pyrimethamine and sulfadiazine. These medicines are recommended for use after 18 weeks of pregnancy. This is because if you take them before 18 weeks of pregnancy, they may cause birth defects in your baby.

How is toxoplasmosis treated in my baby after birth?

If your baby shows symptoms of toxoplasmosis, she gets treated with the antibiotics pyrimethamine and sulfadiazine. She continues these antibiotic treatments through her first birthday, sometimes even longer.

How can I prevent toxoplasmosis?

Here’s how to protect yourself from toxoplasmosis:

• Don’t eat raw or undercooked meat, especially lamb or pork. Cooked meat should not look pink, and the juices should be clear.
• Wash your hands with soap and water after handling fruits, vegetables or raw meat.
• Don’t touch your eyes, nose or mouth when handling raw meat.
• Clean cutting boards, work surfaces and utensils with hot, soapy water after using them with fruits, vegetables or raw meat.
• Peel or thoroughly wash all raw fruits and vegetables before eating.
• Use work gloves when you’re gardening. Wash your hands afterwards.
• Don’t let your cat go outside your home where it may come in contact with the parasite.
• Ask someone else to clean your cat’s litter box. If you have to do it yourself, wear gloves. Wash your hands thoroughly when you’re done emptying the litter.
• Stay away from children’s sandboxes. Cats like to use them as litter boxes.

Syphilis

Syphilis is a sexually transmitted infection (STI) or sexually transmitted disease (STD). Syphilis is caused by a bacterial infection (Treponema pallidum) and can cause serious health problems if left untreated. However, syphilis is easy to cure if found early. A pregnant woman with syphilis can pass the infection on to her baby through the placenta before it is born, causing birth defects, seizures, developmental delay or miscarriage and stillbirth.

If you have syphilis and don’t get treated right away, you can pass the infection to your baby. Up to 2 in 5 babies (40 percent) born to women with untreated syphilis die from the infection. Most of the time, syphilis is passed from mom to baby during pregnancy, but it can happen during vaginal birth if a baby has direct contact with a syphilis sore. Vaginal birth is when contractions in your uterus (womb) help push your baby out through the vagina. When your baby is born with syphilis, it’s called congenital syphilis.

At your first prenatal care visit, your health care provider does a blood test to check for sexually transmitted infections (STIs) like syphilis. Your provider also asks about your sexual history to see if you may be at risk for having syphilis. A sexual history is a set of questions your provider asks about your sex life. For example, your provider asks about your sex partners, what kinds of sex you have, if you use birth control, if you’ve had a sexually transmitted disease (STD) in the past and how you protect yourself from sexually transmitted infections (STIs). If your provider thinks you may have syphilis or another sexually transmitted disease (STD) based on your sexual history, she may test your blood again in your third trimester and after you give birth.

The best way to prevent getting syphilis and other sexually transmitted infections (STIs) is to have safer sex. This means using a condom every time you have sex.

• use a condom when you have vaginal, oral or anal sex.
• wash your hands immediately after sex and avoid hand-to-eye contact
• don’t have sex with someone who knows they have syphilis, even with a condom, until after they have completed their treatment.

You also can get syphilis by having direct contact with (touching or kissing) an infected person’s syphilis sore. Sores usually are found on the external genitals (sex organs) or in the vagina, anus or rectum. They also can be on a person’s lips and in the mouth.

Syphilis in pregnancy key points:

• Syphilis is an infection that is completely preventable.
• If you’re pregnant and have syphilis, get treatment right away. Getting early treatment can help protect you and your baby.
• Syphilis during pregnancy can cause problems for your baby, like miscarriage, premature birth, stillbirth and death after birth.
• Ask your partner to get tested and treated for syphilis. Even if you get treatment, he can reinfect you if he doesn’t get treatment.

Can syphilis during pregnancy cause problems for your baby?

Yes. Having syphilis can cause problems during pregnancy, including:

• Miscarriage. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy.
• Premature birth. This is birth that happens too soon, before 37 weeks of pregnancy.
• Fetal growth restriction (also called growth-restricted, small for gestational age or small for date) and low birthweight. Fetal growth restriction is when a baby doesn’t gain the weight she should before birth. Low birthweight is when a baby is born weighing less than 5 pounds, 8 ounces.
• Problems with the placenta and the umbilical cord. The placenta grows in your uterus (womb) and supplies your baby with food and oxygen through the umbilical cord. Congenital syphilis may cause the placenta to grow large and the umbilical cord to be swollen, which can cause problems with how they work to support your baby in the womb.
• Stillbirth. This is when a baby dies in the womb after 20 weeks of pregnancy.

Having syphilis during pregnancy can cause problems for your baby after birth, too, including neonatal death and serious lifelong health conditions for your baby. Neonatal death is when a baby dies in the first 28 days of life.

Stillbirth and neonatal death are more likely to happen to your baby if you have syphilis and don’t get treated.

How can you protect yourself from syphilis?

Here’s what you can do:

• Don’t have sex. This is the best way to protect yourself from STIs, including syphilis.
• If you do have sex, have safe sex. Have sex with only one person who doesn’t have other sex partners. If you’re not sure if your partner has an STI, use a barrier method of birth control. Barrier methods include male and female condoms and dental dams. A dental dam is a square piece of rubber that can help protect you from STIs during oral sex.
• Go to all your prenatal care checkups, even if you’re feeling fine. Many cases of syphilis happen in women who don’t get regular prenatal care. At your prenatal care checkups, your provider asks you questions to see if you may be at risk for syphilis and other infections that can affect your pregnancy. If you’re at risk for syphilis, your provider gives you a blood test to see if you have the infection.
• Get tested and treated. If you think you may have syphilis, tell your provider right away. He can test you for syphilis and begin treatment if you’re infected.
• The sooner you’re treated, the less likely you and your baby are to have complications from your infection.
• Ask your partner to get tested and treated for syphilis. If you get treated for syphilis, you’re no longer infected. But if your partner is infected, you can get infected again. This is called reinfection. Ask your partner to get tested and treated to protect you from infection and reinfection.

What are the signs and symptoms of syphilis?

The symptoms of syphilis will depend on the stage of infection. Some people may not have any symptoms at all. There are four stages of syphilis infection: primary, secondary, latent and tertiary.

Signs and symptoms of syphilis depend on how long you’ve been infected and when you get treatment. Even if your signs and symptoms go away without treatment, the infection can get worse. If you think you have syphilis, tell your doctor. If you’re pregnant, have syphilis and get treated for syphilis before 26 weeks of pregnancy, your baby is probably safe from syphilis infection.

Signs and symptoms of syphilis happen over time in stages. The stage you’re in depends on whether or not you get treatment. Treatment usually is with an antibiotic called penicillin. Antibiotics are medicines that kill infections caused by bacteria. Treatment can prevent you from moving to the next stage, so it’s important to get treated as soon as you know you’re infected.

Primary syphilis (10-90 days after infection)

The first sign of syphilis is a small, hard, painless sore called a chancre that usually develops in the genital or vaginal area. You may have one or a few sores. They last for about 6 weeks, even if you get treatment.

• a painless sore (or sometimes multiple sores) called a chancre appears in the mouth, anus, penis, vagina or cervix.
• it looks like a roundish area of broken skin that has an infected centre.
• it can be weepy and have pus coming from it.
• the sore often goes unnoticed because it is usually painless and may be hidden from view (e.g. in the rectum or on the cervix).
• the sores usually clear up after 2 to 6 weeks but the infection remains in your body

Secondary syphilis (7-10 weeks after infection)

In the second stage, you have sores and a rash on the palms of your hands and on the bottoms of your feet. You also may have:

• Symptoms that include a red rash on the palms, soles, chest or back, fever, enlarged glands in the armpits and groin, hair loss, headaches and tiredness
• Rash is slightly lumpy, but not itchy or painful
• Fever
• Swollen lymph nodes. Lymph nodes are glands throughout the body that help fight infection. You usually can’t feel lymph nodes unless they’re swollen.
• Sore throat
• Hair loss
• Headaches
• Weight loss
• Muscle aches and fatigue. Fatigue is being really tired and having little energy.
• The symptoms may go unnoticed

Latent syphilis

In this stage, your signs and symptoms go away, but you’re still infected. The infection can stay in your body for years without having any signs or symptoms.

• no noticeable symptoms, but the body still has the infection
• if syphilis is not treated at this stage it may remain latent (dormant) for life or it can develop into tertiary syphilis

Tertiary syphilis

If you don’t get treatment for syphilis (develops in about one third of people with untreated latent syphilis), you can have signs and symptoms later in life, including:

• In this stage, the bacteria can damage almost any part of the body including the heart, brain, spinal cord, eyes and bones, resulting in mental illness, blindness, deafness, neurological problems, heart disease and even death
• Neurological problems. These affect the brain, spinal cord and nerves throughout the body. You may have problems with coordination and may have numbness or paralysis. Paralysis is when you can’t feel or move one or more parts of your body. You also may develop dementia. This is when you have problems thinking, remembering, communicating and doing daily activities.
• This can happen many years after the primary infection

How is syphilis treated?

Syphilis can be easily treated with an injection of antibiotics. If you have primary or secondary syphilis, one shot of penicillin usually can cure the infection. If you have latent or late syphilis, you may need more than one shot.

The length of treatment depends on the stage of infection.

You will need to have follow-up blood tests to make sure the infection is gone. You should not have sex, even with a condom, until your doctor tells you your treatment has been successful. The sooner you seek treatment for syphilis the better. Treatment is also recommended if you have been in contact with someone who has tested positive to syphilis.

Varicella-zoster (chickenpox)

Varicella is also called chickenpox, is a common infection in children. It can be harmful to your unborn baby or newborn if you get it during pregnancy, but most likely your baby will be born healthy. However, some babies may get congenital varicella syndrome. This is a group of birth defects that can include:

• Scars
• Problems with muscles and bones
• Arms or legs that are paralyzed or not formed correctly
• Blindness
• Seizures
• Learning problems
• Microcephaly. This is a birth defect in which a baby’s head is smaller than expected, compared to babies of the same sex and age.

Only about 1 or 2 out of 100 babies (1 to 2 percent) whose mothers had chickenpox during the first 20 weeks of pregnancy get congenital varicella syndrome. Your doctor can do an ultrasound to check for some birth defects caused by chickenpox.

Birth defects are very rare when you get infected with chickenpox after 20 weeks of pregnancy. But your baby could have problems with his central nervous system (brain and spinal cord) if you get infected in the third trimester of pregnancy.

Infection after 20 weeks of pregnancy also may cause shingles in your baby during the first 1 to 2 years of life. Shingles (also called herpes zoster) is an infection caused by the same virus that causes chickenpox. A person with shingles has painful clusters of blisters that usually appear on a small area of the body. Shingles doesn’t seem to cause birth defects or infections in your baby.

You probably don’t need to worry about chickenpox if you’ve had it before or if you’ve had the chickenpox vaccine. Both of these can help make you immune to chickenpox. Immune means being protected from an infection. If you’re immune to an infection, it means you can’t get it. About 9 out of 10 pregnant women (90 percent) are immune to chickenpox. A vaccine is a medicine you get that helps protect against certain diseases.

Many women don’t know if they’re immune to chickenpox. If you’re not sure, talk to your health care provider about chickenpox during your first prenatal visit.

Chickenpox is caused by a virus. People usually get it during childhood. Its symptoms include an itchy rash, blisters and fever. These symptoms show up about 2 weeks after you get the chickenpox virus. The infection usually isn’t dangerous in children. But 1 to 2 out of 10 pregnant women (about 10 to 20 percent) who get chickenpox get a dangerous form of pneumonia (a kind of lung infection).

You can get chickenpox by being in contact with someone else’s chickenpox rash. It’s also spread through the air when someone with chickenpox coughs or sneezes. An infected person can spread chickenpox starting 1 to 2 days before the rash appears and until the rash stops spreading and is covered by dry scabs. This usually is about 5 days after the rash starts.

What are the chances of getting chickenpox during pregnancy?

About 1 out of 1,000 pregnant women in the United States gets chickenpox. Most children get chickenpox vaccines, so the chances of getting it are becoming even lower.

Nine out of 10 pregnant women (90 percent) who aren’t immune to chickenpox get the infection when someone else in their home has it.

How is chickenpox treated during pregnancy?

If you get chickenpox while you’re pregnant, your provider gives you an antiviral called acyclovir to help with the symptoms. An antiviral is a medicine that kills infections caused by viruses. Studies have shown that this medicine is safe during pregnancy. If you start to get any signs of pneumonia, you need to be hospitalized and treated with a higher amount of antivirals through an IV (when medicine is given through a needle into a vein.).

Can I get chickenpox from a child who just had a vaccine?

Not usually, but it can happen if a child gets sores after having the vaccine. Sores can appear around the area where the child got the vaccine. Make sure your children are vaccinated for chickenpox at ages 12 to 15 months and at 4 to 6 years. Your chances of getting chickenpox from a child who recently had a vaccine are much lower than the chances of getting it from a child who doesn’t have the vaccine.

How can you avoid chickenpox during pregnancy if I’m not immune?

First, get a blood test to find out if you’re immune to chickenpox. Get tested if you’re pregnant or planning to get pregnant. If you’re not immune, you can get a vaccine. It’s best to wait 1 month after the vaccine before getting pregnant.

If you’re already pregnant, don’t get the vaccine until after you give birth. In the meantime, avoid contact with anyone who has chickenpox or shingles.

If you’re not immune to chickenpox and you come into contact with someone who has it, tell your provider right away. Your doctor can treat you with medicine that has chickenpox antibodies. It’s important to get treatment within 4 days after you’ve come into contact with chickenpox to help prevent the infection or make it less serious.

Also, tell your doctor if you come in contact with a person who has shingles. Your doctor can treat you with the antiviral acyclovir.

How is chickenpox treated in your newborn baby?

If your newborn has the serious form of the infection, your provider treats your baby right after birth with medicine that has chickenpox antibodies. Antibodies are cells in the body that fight off infection. The medicine can help prevent chickenpox in your baby or make it less dangerous.

If your baby still gets chickenpox after getting treated, she can be treated with an antiviral like acyclovir.

Can chickenpox hurt your newborn baby?

It depends on when the infection happens. If you get a chickenpox rash about 1 to 3 weeks before giving birth, there’s some chance that you can pass the infection to your baby. But if that happens, the infection is usually mild.

But if you get a chickenpox rash the week before you give birth or within a couple days after giving birth, there is up to a 3 in 10 chance (30 percent) that your baby will get a serious, even deadly, form of the infection.

Parvovirus B19

Parvovirus B19 infection is also known as fifth disease, slapped cheek, slapped face or erythema infectiosum. Parvovirus B19 infection is spread when an infected person talks, coughs or sneezes small droplets containing infectious agents into the air. The droplets in the air may be breathed in by those nearby. Parvovirus B19 infection may be spread by contact with hands, tissues and other articles soiled by infected nose and throat discharges. Parvovirus B19 infection may also be transmitted from a pregnant woman to her fetus.

Infection by parvovirus B19 generally causes only a mild illness. In children, it starts with cold-like symptoms followed by a rash. However, if a pregnant woman is infected, parvovirus B19 infection may be transmitted to the fetus. In less than 5% of cases, parvovirus B19 infection may cause the unborn baby to have severe anemia (low blood count) and the woman may have a miscarriage and stillbirth. This occurs more commonly if parvovirus B19 infection occurs during the first half of pregnancy. There is no evidence that parvovirus B19 infection causes birth defects or mental retardation. Still, a pregnant woman who has been exposed to parvovirus B19 should seek the advice of the doctor managing her pregnancy, although there is no universally recommended approach to monitoring of a woman in this situation.

Parvovirus B19 infection (fifth disease, slapped cheek, slapped face or erythema infectiosum) key points:

• Fifth disease is a common childhood illness. It often starts with cold-like symptoms followed by a rash.
• If you’ve had fifth disease, you can’t get it again. If you do get it during pregnancy, it usually doesn’t cause problems.
• If you get infected during pregnancy, you can pass it to your baby. This can cause miscarriage or stillbirth, but this is rare.
• To help prevent fifth disease infection, wash your hands often with soap and water, especially after being around children.

What problems can parvovirus B19 infection cause in pregnancy?

Parvovirus B19 infection (fifth disease) usually doesn’t cause problems for pregnant women and their babies, but it can affect the way the body makes red blood cells. Red blood cells carry oxygen throughout the body. You may have complications from fifth disease if you have:

• Sickle cell anemia. Sickle cell anemia is the most common form of sickle cell disease (also called SCD). Sickle cell disease is a condition in which the red blood cells in your body are shaped like a sickle (like the letter C). In a healthy person, red blood cells are round and flexible. They flow easily in the blood. A person with sickle cell disease has red blood cells that are stiff and can block blood flow. This can cause pain, infections, organ damage and stroke.
• A weak immune system due to cancer (like leukemia blood cancer) or HIV infection. HIV stands for human immunodeficiency virus. It’s a virus that attacks the body’s immune system. Over time, HIV can destroy the cells in the immune system so that it can’t protect the body. When this happens, HIV can lead to AIDS (acquired immune deficiency syndrome).

If you get infected with parvovirus B19 infection (fifth disease) during pregnancy, the virus can make it hard for your baby to make red blood cells. Rarely, this can lead to a severe anemia that can cause:

• Hydrops fetalis. This is -a buildup of fluid in your baby’s body. Hydrops can cause heart failure and death.
• Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy.
• Stillbirth. This is when is when a baby dies in the womb after 20 weeks of pregnancy.

These kinds of serious problems happen in less than 1 in 20 (5 percent) of women who become infected during pregnancy. They usually happen during the first half of pregnancy.

Who is at risk of getting parvovirus B19 infection (fifth disease)?

Parvovirus B19 infection (fifth disease) is common in children 5 to 15 years old. People with young children and those who work with children (like child care providers and teachers) are most likely to get infected with fifth disease. If a child in your home has fifth disease, there is a 1 in 2 chance (50 percent) that another family member who hasn’t had the infection will get it. Remember that once you’ve had fifth disease, you can’t get infected again.

What are the signs and symptoms of parvovirus B19 infection?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy. Signs and symptoms of parvovirus B19 infection (fifth disease) usually appear between 4 and 14 days after infection.

Signs and symptoms of parvovirus B19 infection (fifth disease) are usually mild and may include:

• Rash on the face, sometimes called a slapped-cheek rash. A rash is most common in children younger than 10. The rash often spreads to the arms, legs and torso. It can last from 1 to 3 weeks. A child with fifth disease is most contagious before the rash appears and isn’t contagious after the rash appears.
• Fever
• Runny nose, sore throat and swollen glands
• Headache
• Diarrhea
• Joint pain or swollen joints, especially in older teens and adults. Fifth disease most often affects the hands, wrists, knees and ankles.
• Red eyes

About 1 in 5 people (20 percent) who gets infected with fifth disease doesn’t have any signs or symptoms.

If you think you’ve come in contact with fifth disease or you have signs or symptoms, tell your health care provider right away. If you have a rash, your provider may be able to diagnose fifth disease during a physical exam. If you don’t have a rash, your provider can test your blood for the infection.

How is parvovirus B19 infection treated?

Parvovirus B19 infection (fifth disease) is usually mild and goes away on its own. If you’re pregnant and have parvovirus B19 infection (fifth disease), your health care provider monitors your pregnancy closely to check for problems with your baby. If your baby has parvovirus B19 infection (fifth disease), chances are the infection will go away on its own. Your doctor checks your baby’s health during routine prenatal care checkups.

Your doctor may recommend that you have ultrasounds to check your baby’s health. An ultrasound is a prenatal test that uses sound waves and a computer screen to show a picture of your baby inside the womb. If an ultrasound shows that your baby is having problems, your doctor may recommend amniocentesis (also called amnio) to confirm the infection. Amniocentesis is a prenatal test that takes amniotic fluid from around your baby in the uterus (also called womb). The fluid is tested to see if your baby has certain health conditions.

If an ultrasound shows that your baby has hydrops fetalis, your doctor may use a procedure called cordocentesis to find out how severe your baby’s anemia is. For this test, your provider inserts a thin needle into an umbilical cord vein to take a small sample of your baby’s blood. If your baby has severe anemia, your doctor may be able to treat it by giving her a blood transfusion (new blood) through the umbilical cord. In most cases, the anemia isn’t severe.

If your baby has hydrops fetalis during the third trimester, you may need to have your labor induced to give birth early for your baby’s health. Inducing labor (also called labor induction) is when your health care provider gives you medicines or uses other methods to start your labor.

How can you protect yourself from parvovirus B19 infection during pregnancy?

To protect yourself from parvovirus B19 infection (fifth disease):

• Wash your hands often with soap and water, especially after being around children.
• Carefully throw away tissues used by children and wash your hands right away.
• Don’t share food and drinks with other people.
• Avoid close contact with people who are sick.

Rubella

Rubella is the virus that causes German measles, is an infection that causes mild flu-like symptoms and a rash on the skin. Only about half of people infected with rubella have these symptoms. Others have no symptoms and may not even know they’re infected.

Rubella is only harmful to an unborn baby in the womb. If you get infected during pregnancy, rubella can cause serious problems for your baby. If contracted early in the pregnancy, an infant may develop heart disease, retarded growth, hearing loss, blood disorders, vision problems, or pneumonia. Problems that may develop during childhood include central nervous system disease, immune disorders, or thyroid disease.

Rubella is caused by the rubella virus that’s spread through personal contact, or by coughing and sneezing. Once you have had rubella then you normally develop a lifelong immunity against further infection. Rubella is best prevented by the MMR (measles, mumps and rubella) vaccination. It’s recommended children are immunized against rubella as part of their routine childhood immunization program.

Rubella has been eliminated in the United States because of routine MMR vaccination of children. Vaccination protects a person against rubella for life. Only five cases of rubella were reported in this country between 2001 and 2004. But women who were never vaccinated as children can get infected.

Rubella is common in many other countries. Travelers can bring it into the United States, or you can get it when traveling outside the country.

It’s important to get vaccinated for rubella. Talk to your health care provider to make sure you’re protected against it.

Most women have been vaccinated against rubella and are immune, but this immunity can wear off over time. It is advisable to be tested for your rubella immunity status before becoming pregnant. You can be vaccinated if your immunity is low, but you should take care to avoid getting pregnant within 28 days of your vaccination.

Congenital rubella syndrome

If a pregnant woman who does not have immunity to rubella (either due to previous infection or vaccination) catches the rubella virus, then the virus can be passed on to her unborn baby.

Rubella virus can disrupt the development of your baby, causing a series of birth defects that are known as congenital rubella syndrome.

The risk of congenital rubella syndrome affecting the baby and the extent of the birth defects it causes depends on how early in the pregnancy the mother is infected. The earlier in the pregnancy the greater the risks. Congenital rubella syndrome can include hearing and visual impairments, developmental delay and other problems in the baby.

As many as 9 out of 10 babies whose mother caught rubella during the first 10 weeks of pregnancy will have congenital rubella syndrome, with multiple birth defects. After 20 weeks there is no risk of the baby developing congenital rubella syndrome.

Symptoms of rubella

About half of people with rubella have signs and symptoms, and half don’t. Symptoms of rubella include a distinctive red-pink skin rash, swollen glands (nodes), and cold-like symptoms such as a mild fever, sore head and runny nose.

Rubella’s incubation period is between 2 and 3 weeks with its infectious period lasting from 1 week before the rash first appears until at least 4 days after it’s gone.

Rubella is usually mild with flu-like symptoms followed by a rash. The rash often lasts about 3 days. Flu-like symptoms include:

• Low-grade fever
• Headache
• Runny nose
• Red eyes
• Swollen glands
• Muscle or joint pain

What problems can rubella cause during pregnancy?

Rubella can be a serious threat to your pregnancy, especially during the first and second trimesters. Having rubella during pregnancy increases the risk of:

• Congenital rubella syndrome – This is a condition that happens when a mother passes rubella to her baby during pregnancy. It may cause a baby to be born with one or more birth defects, including heart problems, microcephaly, vision problems, hearing problems, intellectual disability, bone problems, growth problems, and liver and spleen damage.
• Miscarriage – This is when a baby dies in the womb before 20 weeks of pregnancy.
• Stillbirth – This is when a baby dies in the womb after 20 weeks of pregnancy.
• Premature birth – This is birth that happens too early, before 37 weeks of pregnancy.

Can I pass rubella to my baby during pregnancy?

Yes. The best way to protect your baby is to make sure you’re immune to rubella. Immune means being protected from an infection. If you’re immune to an infection, it means you can’t get the infection.

Most likely you’re immune to rubella because you were vaccinated as a child or you had the illness during childhood. A blood test can tell whether or not you’re immune to rubella. If you’re thinking about getting pregnant and aren’t sure if you’re immune, talk to your health care provider about getting a blood test.

If you’re not immune to rubella, here’s what you can do to help protect your baby:

• Before pregnancy. Get the measles, mumps and rubella (MMR) vaccine. Wait 1 month before trying to get pregnant after getting the shot.
• During pregnancy. You can be tested at a prenatal visit to make sure you’re immune to rubella. If you’re not immune, the MMR vaccine isn’t recommended during pregnancy. But there are things you can do to help prevent getting infected with rubella:
  • Stay away from anyone who has the infection.
  • Tell your health care provider right away if you’ve been in contact with someone who has rubella.
• After pregnancy. Get the MMR vaccination after you give birth. Being protected from the infection means you can’t pass it to your baby before she gets her own MMR vaccination at about 12 months. It also prevents you from passing rubella to your baby during a future pregnancy.

What are the chances of passing rubella to your baby during pregnancy?

You’re more likely to pass rubella to your baby the earlier you become infected during pregnancy. For example:

• If you get rubella in the first 12 weeks of pregnancy, your baby has about an 8 to 9 in 10 chance (85 percent) of getting infected.
• If you get rubella at 13 to 16 weeks of pregnancy, your baby has about a 1 in 2 chance (50 percent) of being infected.
• If you get rubella at the end or your second trimester or later, your baby has about a 1 in 4 chance (25 percent) of getting infected.

If you have rubella during pregnancy, your baby’s doctor carefully monitors your baby after birth to catch any problems early.

Cytomegalovirus (CMV)

Cytomegalovirus (CMV) is another viral infection that a mother may have acquired. Cytomegalovirus (CMV) often doesn’t cause any obvious symptoms, so you may not know you’re infected. It’s possible for an unborn child to become infected with cytomegalovirus (CMV). More than half of all American adults have been infected with cytomegalovirus (CMV) at some point in their life and, in most cases, it does not cause severe illness. However, it may pass to a baby during the birth process and can also infect newborns through breast milk. Your baby could be born with cytomegalovirus (CMV), this is called congenital cytomegalovirus (CMV). Infected infants may have severe problems, such as hearing loss, vision problems, mental retardation, pneumonia, and seizures. This seems to be more likely in babies whose mothers get a new infection, rather than in mothers who have carried the virus for a long time.

Cytomegalovirus (CMV) is a common virus, especially in babies and young children. It’s only carried by humans, not other animals.

Cytomegalovirus (CMV) is a member of the same virus family that causes chickenpox, cold sores and glandular fever. All of these viruses, including cytomegalovirus (CMV), can stay alive though inactive in your body for many years after you first become infected.

Cytomegalovirus (CMV) is transmitted from person to person through contact with body fluids, such as saliva, nasal mucous, urine, vaginal secretions, semen and breast milk.

About half of all American women are thought to have had cytomegalovirus (CMV) by the time they get pregnant.

Some women pick up cytomegalovirus (CMV) while pregnant. This happens through handling infected children’s toys, dirty tissues or soiled nappies. It is also possible to get cytomegalovirus (CMV) from having sex, a blood transfusion or an organ transplant.

Unborn babies can get cytomegalovirus (CMV) from their mothers while in the womb. Very occasionally, babies can get infected with cytomegalovirus (CMV) during breastfeeding.

Cytomegalovirus symptoms

Cytomegalovirus (CMV) usually doesn’t cause any noticeable symptoms. However, in some people, it can cause mild symptoms similar to those of glandular fever, such as fever, swollen glands, and a cough or cold.

Cytomegalovirus (CMV) can cause serious illness in people who are infected with HIV or who are having chemotherapy for cancer. But most people never find out they have cytomegalovirus (CMV) infection, or have had it before.

Can cytomegalovirus be prevented?

The best way to try to avoid getting infected with cytomegalovirus (CMV) is by practicing good hygiene.

If you are pregnant, it is a good idea to:

• regularly and thoroughly wash your hands with soap and water, particularly when caring for children or handling anything with body fluids on it
• regularly clean surfaces and objects that may have body fluids on them
• wear gloves when changing nappies
• avoid contact with children’s saliva
• avoid sharing food, cups, utensils, or toothbrushes

There is no vaccine to prevent cytomegalovirus (CMV) infection.

Herpes infections

Genital herpes is a sexually transmitted infection (STI) which shows as blisters or sores on the genitals. Genital herpes is caused by the herpes simplex virus (HSV). HSV Type 1 is more common on the mouth (cold sores) and HSV Type 2 on the genitals, but both viruses can infect the mouth and genital area. Both of these infections can recur. Herpes simplex virus (HSV) is most commonly acquired through oral or genital contact. Newborns who contract the virus usually do so during travel through the birth canal of a woman who has a genital infection with herpes simplex virus (HSV). The herpes simplex virus (HSV) may spread throughout the newborn’s body, attacking vital organs. Treatment with specific antiviral medication should begin as soon as possible in the infected newborn. Even if treated, surviving babies may have permanent damage to their central nervous system.

Pregnancy and herpes

An infected mother can pass herpes simplex virus (HSV) on to her baby during pregnancy or at birth, causing serious illness. This is most serious in women who have their first symptoms of herpes just before giving birth. Women who already have the virus when they get pregnant have protective antibodies which protect the baby too, so it’s very unlikely to be infected. If you become pregnant, tell your doctor if you or your partner have ever had herpes. Your doctor can then work out the risk at birth and any possible risk to the baby.

How do I get genital herpes?

Genital herpes is spread by skin-to-skin contact with someone who already has the virus, including contact with infected skin during sex. Cold sores on the mouth can spread the virus to the genitals during oral sex.

There is no cure for herpes. Once you have the virus, it stays in the nerves of the infected area of skin. It can appear to go away for some time and then flare up.

Herpes is most infectious from the first signs of sores developing (tingling of the skin, numbness or shooting pains) until the scabs have gone.

You can pass on herpes to someone even when you have no visible blisters or sores. This is most likely in the first 2 years of infection.

You can’t catch herpes or pass it on to another person unless you have skin-to-skin contact with the infected area.

Genital herpes signs and symptoms

When you are first infected, you may not get sores. Many people with genital herpes don’t know they have it because they have no symptoms.

The first time you get sores or blisters (called a herpes ‘episode’) is usually the worst. You may feel generally unwell as if you are getting the flu, then small blisters appear. They burst and become sores. Later, scabs form, and finally the skin heals after 1 or 2 weeks.

In girls and women, blisters may appear around the vagina, the urethra, the cervix, or between the vagina and the anus, or around the anus.

In boys and men, blisters may appear on the penis and foreskin, and sometimes inside the urethra, on the scrotum or in the area between the penis and the anus, or around the anus. It can be very painful to urinate if the urine runs over the sores.

Rarely, herpes can appear on the buttocks, lower back and other areas below the waist, as well as the hands, breasts, back, fingers – anywhere that has touched an infected area.

Many cases of genital herpes don’t show up as blisters. They can appear as a small area of rash, cracked skin, or some other skin condition on the genitals.

Although herpes sores heal, the virus stays in the body, and you can have more outbreaks. These are called ‘recurrent episodes’.

How do I know I have genital herpes?

Have any unusual condition of the genital skin checked out by your doctor and tested for herpes.

The doctor will take a sample from an infected area with a swab and send it to a laboratory. It’s best if the sore or blister is less than 4 days old. You may need a blood test as well to see which type of HSV you have.

How can genital herpes be prevented?

You can reduce the risks of getting genital herpes by following this advice:

• To protect yourself and your partner, avoid sex when there are any signs of sores on the genitals. Don’t have oral sex when there is any sign of a cold sore on the mouth.
• Condoms with water-based lubricant and dental dams reduce the risk, but they only protect the area of skin covered by the condom or dam. They do protect you against other sexually transmitted infections (STIs).

Talking about STIs can be difficult, but any person you have sex with has a right to know if you have an infection. Discuss it when you are feeling relaxed and confident, not just before you have sex. Your partner will appreciate your honesty and that you don’t want to infect him/her. You have the right to know if they are infected, too.

Is there a vaccine for genital herpes?

There is no vaccination for genital herpes.

How is genital herpes treated?

Your doctor may prescribe anti-viral drugs. These ease the pain and severity of the sores or blisters, especially if you take them within 2 days of any sign of blisters. If you have lots of outbreaks you need to take medicine all the time. Anti-viral drugs can’t cure you or stop you passing herpes on to another person. However, they can reduce the symptoms, and lower the risk of infecting another person when you don’t have any symptoms.

During an episode of genital herpes

These treatment tips may help ease the symptoms:

• Acetaminophen (paracetamol) or aspirin can reduce pain and soreness.
• Bathing sores with salt water (2 teaspoons of salt per liter, or 1 cup of salt in a bath) can help them heal.
• Applying an anesthetic jelly or cream can reduce the pain, particularly when urinating.
• If it hurts to urinate, you can also try urinating while sitting in a warm bath.