Исследование серологической распространенности факельных инфекций и их корреляции с неблагоприятными репродуктивными исходами у женщин с тяжелым акушерским анамнезом

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Al-Karawi, A. S. (2023). Исследование серологической распространенности факельных инфекций и их корреляции с неблагоприятными репродуктивными исходами у женщин с тяжелым акушерским анамнезом. in Library, 4(4), 209–215. извлечено от https://inlibrary.uz/index.php/archive/article/view/29508
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Аннотация

Справочная информация: Термин TORCH-инфекции относится к группе заболеваний, включая токсоплазму, другие инфекции (сифилис, ветряная оспа, парвовирус B19), краснуху, цитомегаловирус (ЦМВ) и герпетические инфекции. Это совокупность возбудителей, способных проникать через плацентарный барьер, вызывая впоследствии врожденные инфекции. Часто эти инфекции первоначально протекают бессимптомно и создают серьезные диагностические проблемы во время беременности, потенциально приводя к нежелательным акушерским исходам. Это исследование направлено на изучение корреляции между инфекциями TORCH и перинатальными исходами при беременности, считающейся высоким риском. Методология: Мы обследовали 143 беременных пациентки группы высокого риска в возрасте от 18 до 46 лет из отделения акушерства и гинекологии Багдадской больницы гинекологии и акушерства. Также были включены сотни групп с нормальной беременностью. В группу высокого риска вошли женщины с привычным невынашиванием беременности, врожденными аномалиями развития плода, внутриутробной гибелью плода и внутриутробной смертью новорожденных с низкой массой тела при рождении. Наличие антител IgG и IgM против агентов TORCH в контрольной сыворотке пациентов оценивали с помощью наборов ИФА. Мы сравнили перинатальные исходы между TORCH-серопозитивными и серонегативными беременными женщинами из группы высокого риска. Результаты: Среди 143 беременностей высокого риска значительная часть молодых женщин с низким уровнем рождаемости из разных мест жительства была ко-серопозитивной в отношении инфекций Toxoplasma gondii, вируса краснухи, цитомегаловируса и простого герпеса. Из них 55 случаев (48,4%) были серопозитивными в отношении всех четырех агентов TORCH, тогда как 88 случаев (38%) были серопозитивными в отношении антител к одному-трем агентам TORCH. Серопозитивность по IgG составила 74,5%, серопозитивность по IgM — 31,8% для Toxoplasma gondii, 3,6% для ЦМВ и 0% для инфекций РВ соответственно. Примечательно, что беременности высокого риска с серопозитивностью по TORCH демонстрировали явно сильную корреляцию с исходами привычных абортов. Вывод: Проявления высокого риска, продемонстрированные для инфекций Toxoplasma gondii, вируса краснухи, цитомегаловируса и простого герпеса, тесно связанные с привычными абортами, сравниваются с высокой, но менее значимой ассоциацией у лиц, серопозитивных к одному, двум или трем агентам TORCH.

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Indian Journal of Microbiology Research 2023;10(4):209–215

Content available at:

https://www.ipinnovative.com/open-access-journals

Indian Journal of Microbiology Research

Journal homepage:

https://www.ijmronline.org/

Original Research Article

An examination of the seroprevalence of torch infections and their correlation with
adverse reproductive outcomes in females exhibiting a bad obstetric history

Mohammed Mohammed

1

, May Salem Al-Saadi

1

, Abdullah Salim Al-Karawi

2

*

1

Gilgamesh Ahliya University, College of Health and Medical Technologies, Baghdad, Iraq

2

Dept. of Microbiology, College of Science, Mustansiriyah University, Baghdad, Iraq

A R T I C L E I N F O

Article history:

Received 21-09-2023
Accepted 03-11-2023
Available online 27-12-2023

Keywords:

Bad obstetric history perinatal
outcome
Cytomegalovirus
High- risk pregnancy
Herpes simplex virus
Rubella virus
Seronegative
Seropositivity
Toxoplasma

A B S T R A C T

Background

: The term TORCH infections refer to a group of diseases including Toxoplasma, Other

(syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections.
These are a set of pathogens capable of traversing the placental barrier, subsequently causing congenital
infections. Often these infections are asymptomatic initially and pose significant diagnostic challenges
during gestation, potentially leading to undesirable obstetric outcomes. This research intends to explore the
correlation between TORCH infections and perinatal outcomes within pregnancies deemed high-risk.

Methodology

: We examined 143 high-risk pregnant patients aged 18-46 from the Obstetrics and

Gynecology Department at the Baghdad Gynecology and Obstetrics Hospital. Hundreds of normal
pregnancy group were also included. The high-risk group encompassed women with recurring pregnancy
loss, fetal congenital anomalies, intrauterine fetal death, and low birth weight intrauterine neonatal death.
The presence of IgG and IgM antibodies against TORCH agents in patients’ serum control serum
were assessed using ELISA kits. We compared perinatal outcomes between TORCH seropositive and
seronegative high-risk pregnant women.

Findings

: Among the 143 high-risk pregnancies, a significant proportion of young, low-parity women

from diverse residences were co-seropositive for Toxoplasma gondii, rubella virus, Cytomegalovirus, and
Herpes Simplex infections. Of these, 55 cases (48.4%) were seropositive for all the four TORCH agents
compared to 88 cases (38%) were seropositive for antibodies to one to three of the TORCH agents. IgG
seropositivity was 74.5%, while IgM seropositivity was 31.8% for Toxoplasma gondii, 3.6% for CMV
and 0% for RV infections, respectively. Significantly, high-risk pregnancies with TORCH seropositivities
exhibited a clearly strong correlation with Habitual abortions outcomes.

Conclusion

:

High-risk

manifestations

demonstrated

for

Toxoplasma

gondii,

Rubella

virus,

Cytomegalovirus and Herpes Simplex infections strongly associated with habitual abortions compare to
high but less significant association in those seropositive to one, two or three of the TORCH agents

This is an Open Access (OA) journal, and articles are distributed under the terms of the

Creative Commons

Attribution-NonCommercial-ShareAlike 4.0 License

, which allows others to remix, tweak, and build upon

the work non-commercially, as long as appropriate credit is given and the new creations are licensed under
the identical terms.

For reprints contact:

reprint@ipinnovative.com

1. Introduction

The expression ‘Bad Obstetric History’ (BOH) denotes
prior unfavorable fetal results, encompassing two or more
sequential spontaneous miscarriages, intrauterine fetal

* Corresponding author

.

E-mail address

:

abdullah.s.shaker@uomustansiriyah.edu.iq

(A. S.

Al-Karawi).

demise, retardation of growth, stillbirth, early neonatal
death,

and

congenital

anomalies.

1

Several

possible

etiologies of BOH may encompass genetic determinants,
hormonal

fluctuations,

abnormal

maternal

immune

reactions, and maternal infections.

2

The term ‘high-risk

pregnancy’ is associated with a pregnancy that augments
the mother’s, fetus’s, or neonate’s risk of morbidity or
mortality during gestation or delivery. Such pregnancies

https://doi.org/10.18231/j.ijmr.2023.037

2394-546X/© 2023 Author(s), Published by Innovative Publication.

209


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Mohammed, Al-Saadi and Al-Karawi / Indian Journal of Microbiology Research 2023;10(4):209–215

are complicated by factors that adversely affect pregnancy
outcomes (either maternal, fetal, or both). Interestingly,
while only 10-30% of pregnant women are categorized
as high-risk during their antenatal period, they contribute
to 70-80% of perinatal mortality and morbidity.

3

The

TORCH test is categorized under the Infectious-Disease
Antidiv Titer blood examinations. It quantifies the
presence and concentration of antibodies against a specific
cluster of infectious diseases in the bloodstream. The
TORCH acronym encapsulates a group of acute and
chronic infections that women can potentially acquire
during gestation, resulting in profound implications for
the newborn. These infections can induce a spectrum of
symptomatic congenital disabilities in neonates, collectively
called the TORCH syndrome.

2

A positive IgG antidiv test

generally signifies past exposure to a TORCH agent and
does not necessarily imply a currently active infection. In
contrast, the detection of IgM antibodies is more intricate
and can yield false negative and positive outcomes.

4

Toxoplasmosis is engendered by Toxoplasma gondii, a
parasite ubiquitously found in humans. Maternal infection
can induce severe eye or central nervous system infections
in infants, the later the maternal infection occurs during
gestation, the higher the probability of fetal infection.
Conversely, toxoplasmosis acquired early in pregnancy can
result in a miscarriage or severe birth defects.

2,5,6

Rubella

impacts 0.1-2% of neonates. Birth defects are most likely
to transpire when infants are infected during the initial
eight weeks of gestation.

7,8

Cytomegalovirus (CMV), a

member of the herpesvirus group of infections, can induce
severe complications in infants, such as hearing loss, mental
retardation, pneumonia, hepatitis, or blood disorders.

9

Herpes simplex virus infection can pose a risk if transmitted
to an infant during delivery but generally does not affect
gestation or fetal health.

10

There is a lack of adequate data

on the prevalence and contributing factors among pregnant
women co-infected with TORCH in Iraq. This research
aims to fill this knowledge void by evaluating the status
and factors associated with high-risk pregnancies among
women attending antenatal health care about TORCH
infections. A thorough look on the possibility of any
differences between the 4 major TORCH agents and some
of the TORCH agents in respect to BOH manifestations
was also put in consideration.

2. Materials and Methods

This

prospective

study

involved

patients

attending

laboratories in Baghdad. The participant group comprised
243 women, including 143 with high delivery risk factors
and 100 clinically normal women with prior normal
pregnancies and full-term deliveries. The inclusion criteria
were based on a previous history of 2-3 pregnancy losses,
specifically habitual abortion (HA), intrauterine fetal deaths
(IUFD), neonatal death (NND), congenital malformation

(GM), stillbirth (SB), and low birth weight (LBW).

From each participant, 3 ml of venous blood was

collected under strict aseptic precautions. The serum
was used for serological evaluation of IgM and IgG
antibodies

for

Toxoplasma

gondii,

Rubella

virus,

Cytomegalovirus infections, and Herpes simplex virus
as per the manufacturer’s instructions using ELISA
techniques. The following kits were utilized:

1. Rubella IgG ELISA from BIOTEC Laboratories Ltd.

(UK).

2. Rubella IgM ELISA from BIOKIT, S.A. SPAIN.
3. CMV IgG ELISA from BIOKIT, S.A. SPAIN.
4. CMV IgM ELISA.
5. Toxoplasma gondii IgG Elisa kit from Biotech

Laboratories Ltd. (UK).

6. Toxoplasma gondii IgM from BIOTECH Laboratories

Ltd. (UK).

7. HSV-IgG and IgM Elisa kits from Serion Diagnostics

(Germany).

3. Results

Table 1 presents the demographic characteristics of the
enrolled patients. Occupation, history of contact with cats,
and blood transfusion yielded significant data (P = 0.01).
Residency, however, did not show any significant variations
as demonstrated.

Table 2 displays the age ranges of the recruited patients

along with their symptoms of Bad Obstetric History (BOH).
The majority of BOH cases were observed in the age
groups of 18-27 years for all three selected groups (45.5%,
47.7%, and 37% respectively). Conversely, the lowest
seroprevalence rates were found in the age ranges of 38-
46 years (23.6%, 17%, and 24% respectively) as shown in
Table 2.

Among the 143 cases with BOH manifestations, 55

(38.5%) exhibited TORCH seroprevalence (Table 3).
Habitual abortion was observed in 40 cases (72.7%) within
the TORCH group, while cases of intrauterine fetal death
(IUD) accounted for 3 cases (5.5%), neonatal death (NND)
for 6 cases (10.9%), and congenital malformation (CM),
stillbirth (SB), and low birth weight (LBW) were present
at lower rates (3.6%) respectively. In the group with
seroprevalence of 1 to 3 TORCH agents, habitual abortion
was significantly lower compared to the TORCH group (25
cases [28.4%] versus 40 cases [72.7%]) with a p-value of
0.05. The rates of other BOH manifestations were higher
but not significant compared to those in the TORCH group,
except for LBW which was observed in 22 cases (25%)
with a p-value of 0.05. Notably, habitual abortion within
the TORCH group was significantly higher compared to the
normal pregnancy group as shown in Table 3. Furthermore,
in Table 3, we present the obstetric outcomes for the
TORCH group, where all 55 patients experienced habitual


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Mohammed, Al-Saadi and Al-Karawi / Indian Journal of Microbiology Research 2023;10(4):209–215

211

Table 1:

Demographic profile of patients and normal pregnant ladies

Category

Group

Torch Infected Patient

Normal Pregnant

Women

Odds Ratio

P-value

Residency

Urban

72.73% (40/55)

80% (80/100)

0.64

0.28

Rural

27.27% (15/55)

20% (20/100)

1.56

0.28

Occupation

Employee

72.73% (40/55)

37% (37/100)

4.86

<0.001

Housewife

27.27% (15/55)

63% (63/100)

0.21

<0.001

History of contact with
cats during antenatal life

Yes

65.45% (36/55)

45% (45/100)

2.29

0.01

No

34.55% (19/55)

55% (55/100)

0.44

0.01

History of blood
transfusion

Yes

9.09% (5/55)

0% (0/100)

N/A

<0.001

No

90.91% (50/55)

100% (100/100)

N/A

<0.001

Table 2:

Age range in relation to TORCH seropositivity among patients and controls

Group

Age Range

TORCH Seropositivity Rate

TORCH Group

18-27 years

45.5% (n=25/55)

28-37 years

30.9% (n=17/55)

38-45 years

23.6% (n=13/55)

Single, Double, or Triple Group

18-27 years

47.7% (n=42/88)

28-37 years

35.2% (n=31/88)

38-46 years

17.0% (n=15/88)

Normal Pregnancy Group

18-27 years

37.0% (n=5/100)

28-37 years

39.0% (n=39/100)

38-46 years

24.0% (n=24/100)

Table 3:

Seroprevalences to TORCH agents and to 1, 2 or 3 of TORCH agents and bad obstetric history BOH) patterns

Group

Total Out

of 143

positive
Women

HA

IUD

NND

CM

SB

LBW

TORCH Group

38.5%

(55/143)

72.7%

(40/55)

5.5% (3/55)

16.4% (9/55)

18.2%

(10/55)

5.5% (3/55)

21.8%

(12/55)

P-value (vs
Normal
Pregnancy)

-

<0.001

<0.001

<0.001

<0.001

<0.001

<0.001

Single, Double,
or Triple
Manifestation

61.5%

(88/143)

28.4%

(25/88)

11.4%

(10/88)

12.5%

(11/88)

9.1% (8/88)

13.6%

(12/88)

25% (22/88)

P-value (vs
Normal
Pregnancy)

-

<0.001

<0.001

<0.001

<0.001

<0.001

<0.001

abortion during the first trimester.

Table 4 highlights the significance of seropositivity

for Toxoplasma gondii IgM in combination with Rubella-
IgG, CMV-IgG, and HSV-IgG in the etiology of habitual
abortion. In this group, habitual abortion was reported in
10 out of 12 cases (93.3%), which was significantly higher
than the rates observed in TORCH-IgG (19 out of 14 cases
[46.3%]). Seropositivity for one or two or even three of the
TORCH agents’ IgG resulted in 30 out of 88 cases (34%),

which was significantly lower than the other mentioned
groups. Additionally, Table 4 shows that out of the 100
normal pregnancy cases, 12 cases (12%) were seropositive
for onlyone, two or three of the TORCH infections.

In Table 5, we conducted an analysis to study the effects

of TORCH seroprevalence and seroprevalence of one, two,
or three TORCH agents on the type of BOH manifestations.
The rate of habitual abortion in the TORCH group was
significantly higher (72.7%) compared to the group with


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Mohammed, Al-Saadi and Al-Karawi / Indian Journal of Microbiology Research 2023;10(4):209–215

Table 4:

TORCH IgG and IGM seroprevalences rates with special emphasis on Habitual abortion (HA) rates

Category

Total

HA

IUFD

NND

CM

SB

LBW

Toxo. IgM+
RubellaIgG+
CMV-IgG+
HSV-IgG

12/55

(21.82%)

10/12

(93.3%)

0

0

0

0

2/12 (16.6%)

CMV IgM
Toxo-IgG
CMV-IgG
HSV-IgG

2/55

(3.64%)

0

0

0

0

0

0

Rubella IgG
Toxo-IgG
Rubella-IgG
CMV-IgG
HSV-IgG

41/55

(74.5%)

19/41

(46.3%)

2/41

(4.8%)

3/41 (7.3%)

3/41 (7.3%)

10/41 (24.3%)

4/41 (9.7%)

TORCH -IgG
positivity in
Single or Double
or Triple
TORCH Agents

88/88

(100%)

30/88

(34.09%)

7/88

(7.95%)

12/88

(13.64%)

15/88

(17%)

15/88 (17%)

9/88 (10.2%)

Table 5:

Comparison between the “TORCH Group” and the “single, double, or triple manifestation” group and their odds ratios

Outcome Variable

TORCH Group

Single, Double, or Triple

Manifestation

Odds Ratio

P-value

HA

72.7%

28.4%

4.6

<0.001

IUD

5.5%

11.4%

0.45

0.10

NND

16.4%

12.5%

1.38

0.45

CM

18.2%

9.1%

2.26

0.02

SB

5.5%

13.6%

0.37

0.07

LBW

21.8%

25%

0.84

0.61

seroprevalence of one, two, or three TORCH agents (28.4%)
with a p-value of 0.001. The calculated non- adjusted odds
ratio was found considerably high at 4.6.”

4. Discussion

The widespread utilization of TORCH screening among
clinicians investigating congenital and perinatal infections is
noteworthy. However, questions have been raised regarding
the suitability and specificity of the current screening
methodologies.

1

In patients with bad obstetric history

(BOH), maternal infections are a significant factor in
miscarriage. T. gondii encysted forms can cause fetal
infection in the first trimester and frequently result in
recurrent miscarriages due to their presence in the uterus
with persistent infections and subsequent rupture during
placentation.

7

In accordance with preceding studies, our

current research data identified TORCH infections as
etiological agents in recurrent pregnancy loss, in 55 out
of 143 pregnant women exhibiting BOH symptoms.

9–11

Assessing IgM antibodies in maternal sera can signal the
acute phase of maternal infection and the probability of
congenital transmission of T. gondii.

12

In our research, IgM

antibodies were detected in 10 out of 12 (93.3%) patients
with HA manifestation, which concurs with other studies
reporting approximately 66.3% of T. gondii-infected women
demonstrating an IgM response.

13

It is recommended that

pregnant women undergo testing for TORCH antibodies,
those who experience unfavorable outcomes should take
precautions to avoid infection, such as staying away
from cat litter, ensuring the meat is thoroughly cooked,
and washing their hands after handling raw meat.

14

The

pathophysiology of TORCH infections is different and can
lead to severe clinical symptoms and drastic consequences.
Although it is still a common cause of blindness, congenital
toxoplasmosis can be prevented by taking precautions,
including avoiding contact with cats and raw meat (15).
Cytomegalovirus (CMV) is the most frequent cause of
congenital infection in the United States and numerous other
regions.

15,16

Rubella is preventable by vaccination and linked with

significant morbidity and adverse pregnancy outcomes,
mainly when contracted during the first trimester, leading
to severe fetal consequences.

17

In our research, all serum

samples underwent testing for Rubella-specific IgG and


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Mohammed, Al-Saadi and Al-Karawi / Indian Journal of Microbiology Research 2023;10(4):209–215

213

IgM antibodies, demonstrating a seropositivity rate of
28.5% among cases with a bad obstetric history. Elevated
seropositivity (93.3%) was noted in women experiencing
recurrent abortions, followed by low-birth-weight cases
(21.8%).

18

Implementing routine screening for rubella in all

antenatal cases can enable early detection and appropriate
management to enhance fetal outcomes.

Selective employment of cesarean delivery and antiviral

treatment can assist in reducing the incidence and enhancing
outcomes in neonatal herpes cases.

19

CMV and HSV

possess intrauterine transmission routes and can instigate
significant mortality and morbidity.

20

Our research reported

a seropositivity rate of 3.6% for CMV-specific IgM
among women with BOH. Other investigations conducted
in Iraq have reported seropositivity rates ranging from
6.8% to 8.3% among Iraqi women.

21

A primary CMV

infection during gestation increases the risk of manifesting
symptomatic congenital infection, leading to the loss of
the fetus.

22

Numerous researchers have recommended

the serological evaluation of CMV-specific IgM during
pregnancy.

15

Patients with a confirmed HIV diagnosis

should undergo a check for their toxoplasma antidiv
titers. If results are positive with a CD4 count below
100, it is advisable to administer prophylactic antibiotics
along with antiretroviral therapy until the CD4 cell count
elevates.

23

In neonates, a significant portion, about half, of

the morbidity and mortality from HSV II originates from
a primary infection that women acquire during gestation
or from the reactivation of a previous infection.

24

In

our research, the seropositivity rate for HSV IgM among
BOH patients was null, while a prior study reported
a 2% seropositivity rate in asymptomatic women with
recurrent infections during pregnancy.

25

The seropositivity

rate for HSV IgG among BOH patients in our research
was 11%, analogous to findings reported in another study.

25

Mixed TORCH infections were observed in 55 out of 143
patients (28.5%), typically associated with Toxoplasma IgM
antibodies. Similar reports of mixed infection have been
previously noted.

20

Rubella typically presents as a mild

viral disease in children but occasionally infects adults.
A primary viral infection during pregnancy may lead to
harm to the fetus. In our study, the rubella seropositivity
rate was 28.5%, whereas other investigations have reported
seropositivity rates varying from 4% to 17.7%, with a surge
in incidence noted every 3-4 years.

25

Considering that 10-

20% of women within the childbearing age bracket are
vulnerable to rubella, a rise in the incidence of rubella is
likely to increase the number of pregnant women infected
with rubella.

26

Pregnant women who test positive for

rubella IgG may indicate a past infection with one of these
infectious agents. Testing a second blood sample drawn
two weeks later can compare the antidiv level. Increased
IgG antidiv levels would suggest a recent infection.

27

It

is crucial to highlight that IgM antibodies are not always

specific and may cross-react with other IgMs and proteins.
Reference ranges provided by private laboratories should be
adhered to.

28

Active infection does not directly correlate

with ultrasound growth changes; therefore, ultrasound alone
cannot serve as a diagnostic criterion for confirming or
refuting the diagnosis of rubella.

29

It is worth noting that TORCH screening can yield both

false-positive and false-negative results.

30

IgM antibodies

against TORCH organisms typically persist for about three
months, while IgG antibodies remain detectable for a
lifetime, providing immunity and preventing or reducing
the severity of reinfection. Thus, the presence of IgM
antibodies indicates current or recent infection, while the
absence of IgM antibodies but presence of IgG antibodies
without an increase on serial testing suggests previous
infection or vaccination-induced immunity. Individuals
lacking evidence of either IgM or IgG antibodies specific
to the organism are at risk of infection due to the absence of
demonstrable immunity.

Regarding mixed seropositivity among enrolled women,

we noted that out of the 55 cases positive for TORCH
agents in our study, a significant number exhibited
habitual abortion (HA) manifestations (93.3%). Other
manifestations did not significantly differ between cases
with mixed seropositivity’s. These findings are consistent
with previous reports.

31

Our study clearly demonstrates

the significant role-played by TORCH agents in habitual
abortion, as all 55 women with BOH symptoms experienced
HA during the first trimester (Table 3). These results
align with data presented by previous studies.

32

In our

study, we observed that vaginal bleeding in early pregnancy
emerged as a prevalent complication and the primary reason
for hospitalization during the first and second trimesters.
The underlying mechanisms of habitual abortion (HA)
and its detrimental impact on pregnancy outcomes are not
comprehensively elucidated. Aberrant TORCH infections
may contribute to complications in the first trimester,
which, if left unresolved, can escalate to spontaneous
abortion. Molecular investigations have demonstrated a
notable elevation in placental indicators of oxidative stress
in pregnancies among women with a history of bad obstetric
outcomes (BOH).

33

5. Conclusions

Currently, accurately predicting the outcome of pregnancies
affected by TORCH infections and identifying those that
will result in miscarriage remains challenging. The lack
of accurate prediction for pregnancies with threatened
miscarriage, leading to either survival or spontaneous
miscarriage, may result in unnecessary and potentially
harmful interventions or wasteful procedures. Therefore,
we propose that women diagnosed with TORCH pathology
should be provided with the option of hospital bed rest
or, if declined, should receive counseling on modified bed


background image

214

Mohammed, Al-Saadi and Al-Karawi / Indian Journal of Microbiology Research 2023;10(4):209–215

rest at home. Additionally, psychological counseling and
fetal surveillance should be offered to improve outcomes.
It is crucial to engage patients in discussions regarding the
increased likelihood of operative delivery.

6. Author Contributions

Each author that worked on this project significantly
influenced the research’s design, conduct, and analysis, as
well as the interpretation and analysis of the data. They
all contributed to the original manuscript’s creation or its
thorough intellectual content review. They agreed to be
accountable for every part of the work and accepted its
submission to the current journal.

7. Source of Funding

None.

8. Conflict of Interest

None.

Acknowledgments

We

thank

Gilgamesh

Ahliya

University

University

in

Baghdad/Iraq

(http:/gau.edu.iq),

also

we

thank

Mustansiriyah University in Baghdad/Iraq (http://uom
ustansiriyah.edu.iq) for its support to the achievement of
this work.

References

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women with bad obstetric history: an observation from eastern Nepal.

J Health Popul Nutr

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bad obstetric history.

Indian J Med Microbiol

. 2003;21(2):108–10.

3. Chemir F, Alemseged F, Workneh D.

Satisfaction with focused

antenatal care service and associated factors among pregnant women
attending focused antenatal care at health centers in Jimma town,
Jimma zone, South West Ethiopia; a facility based cross-sectional
study triangulated with qualitative study.

BMC Res Notes

. 2014;7:164.

4. Majella MG, Sarveswaran G, Krishnamoorthy Y, Sivaranjini K,

Arikrishnan K, Kumar SG.

A longitudinal study on high risk

pregnancy and its outcome among antenatal women attending rural
primary health centre in Puducherry, South India.

J Educ Health

Promot

. 2019;8:12. doi:10.4103/jehp.jehp_144_18.

5. Jaideep K, Prashant D, Girija A.

Prevalence of high risk among

pregnant women attending antenatal clinic in rural field practice area
of Jawaharlal Nehru Medical College, Belgavi, Karnataka, India.

Int

J Comm Med Public Health

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their associated risk factors in a rural district of Tanzania.

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Prevalence of torch infections and its associated poor

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care clinic, maternity hospital in Abha, Southwestern Saudi Arabia.

Saudi Med J

. 2020;41(7):757–62.

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et al. The serological profile of herpes virus amongst patients with bad
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Toxoplasmosis among women with

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EMHJ-East Mediterr Health J

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Foodborne Toxoplasmosis.

Clin Infect Dis

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advances and challenges in diagnosis, prevention and treatment.

Ital J

Pediatr

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reactivation Cytomegalovirus (CMV) infection can cause severe fetal
sequelae despite pre-conceptional immunity.

Bull Natl Inst Health Sci

.

2022;140(01):1045.

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in Kuyu District, Ethiopia, 2018: A Case-Control Study.

Interdiscip

Perspect Infect Dis

. 2019;2019:4719636. doi:10.1155/2019/4719636.

18. Cao Y, Qiu L, Zhang Q. Study on the relationship between the history

of abnormal pregnancy and TORCH infection in pregnant woman.

Zhonghua Fu Chan Ke Za Zhi

. 1999;34(9):517–20.

19. Knox AT, Powell SB, Logan LK. Intrauterine herpes simplex virus

infection in a monochorionic twin gestation.

J Pediatric Infect Dis

Soc

. 2012;1(2):157–9.

20. Corey L, Wald A.

Maternal and neonatal herpes simplex virus

infections.

N Engl J Med

. 2009;361(14):1376–85.

21. Aljumaili ZKM, Alsamarai AM, Najem WS.

Cytomegalovirus

seroprevalence in women with bad obstetric history in Kirkuk, Iraq.

J Infect Public Health

. 2014;7(4):277–88.

22. Ciobanu AM, Nicolae G, Corina G, Botezatu R, Furtuna M, Peltecu

G, et al.

Cytomegalovirus Infection in Pregnancy – Counselling

Challenges in the Setting of Generalised Testing.

Maedica (Bucur)

.

2020;15(2):253–7.

23. Pereira-Chioccola VL, Vidal JE, Su C. Toxoplasma gondii infection

and cerebral toxoplasmosis in HIV-infected patients.

Future

Microbiol

. 2009;4(10):1363–79.

24. Whitley R, Arvin A, Prober C, Corey L, Burchett S, Plotkin S, et al.

Predictors of morbidity and mortality in neonates with herpes simplex
virus infections. The National Institute of Allergy and Infectious
Diseases Collaborative Antiviral Study Group.

N Engl J Med

.

1991;324(7):450–4.

25. Ballal M, Bangar R, Sherine A, Bairy I. Seroprevalance of rubella in

BOH cases-A 5 year study.

J Obstet Gynecol India

. 2007;57(5):407–

9.

26. Li Z, Yan C, Liu P, Yan R, Feng Z. Prevalence of serum antibodies

to TORCH among women before pregnancy or in the early period of
pregnancy in Beijing.

Clin Chim Acta

. 2009;403(1-2):212–5.

27. Stamos JK, Rowley AH. Timely diagnosis of congenital infections.

Pediatr Clin North Am

. 1994;41(5):1017–33.

28. Fung JC, Tilton RC. TORCH serologies and specific IgM antidiv

determination in acquired and congenital infections.

Ann Clin Lab

Sci

. 1985;15(3):204–11.

29. Migliucci A, Fraja DD, Sarno L, Acampora E, Mazzarelli LL,

Quaglia F.

Prenatal diagnosis of congenital rubella infection

and ultrasonography: a preliminary study.

Minerva Ginecol

.

2011;63(6):485–9.

30. Wang LC, Yan F, Ruan JX, Xiao Y, Yu Y. TORCH screening used

appropriately in China?– three years results from a teaching hospital
in northwest China.

BMC Pregnancy Childbirth

. 2019;19(1):484.

doi:10.1186/s12884-019-2642-7.


background image

Mohammed, Al-Saadi and Al-Karawi / Indian Journal of Microbiology Research 2023;10(4):209–215

215

31. Rasti S, Ghasemi FS, Abdoli A, Piroozmand A, Mousavi SGA,

Fakhrie-Kashan Z, et al. ToRCH “co-infections” are associated with
increased risk of abortion in pregnant women.

Congenit Anom (Kyoto)

.

2016;56(2):73–8.

32. Akpan UB, Akpanika CJ, Asibong U, Arogundade K, Nwagbata AE,

Etuk S.

The Influence of Threatened Miscarriage on Pregnancy

Outcomes: A Retrospective Cohort Study in a Nigerian Tertiary
Hospital.

Cureus

. 2022;14(11):e31734.

33. Lockwood CJ, Krikun G, Rahman M, Caze R, Buchwalder L, Schatz

F. The role of decidualization in regulating endometrial hemostasis
during the menstrual cycle, gestation, and in pathological states.

Semin

Thromb Hemost

. 2007;33(1):111–7.

Author biography

Mohammed Mohammed,

Ph.D Scholar

https://orcid.org/0000-0003-

3449-6692

May Salem Al-Saadi,

Ph.D Scholar

https://orcid.org/0009-0006-8176-

3713

Abdullah Salim Al-Karawi,

Lecturer

https://orcid.org/0000-0002-

5532-7508

Cite this article:

Mohammed M, Al-Saadi MS, Al-Karawi AS. An

examination of the seroprevalence of torch infections and their
correlation with adverse reproductive outcomes in females exhibiting a
bad obstetric history.

Indian J Microbiol Res

2023;10(4):209-215.

Библиографические ссылки

Kumari N, Morris N, Dutta R. Is screening of TORCH worthwhile in women with bad obstetric history: an observation from eastern Nepal. J Health Popul Nutr. 2011;29(1):77–80.

Turbadkar D, Mathur M, Rele M. Seroprevalence of torch infection in bad obstetric history. Indian J Med Microbiol. 2003;21(2):108–10.

Chemir F, Alemseged F, Workneh D. Satisfaction with focused antenatal care service and associated factors among pregnant women attending focused antenatal care at health centers in Jimma town, Jimma zone, South West Ethiopia; a facility based cross-sectional study triangulated with qualitative study. BMC Res Notes. 2014;7:164.

Majella MG, Sarveswaran G, Krishnamoorthy Y, Sivaranjini K, Arikrishnan K, Kumar SG. A longitudinal study on high risk pregnancy and its outcome among antenatal women attending rural primary health centre in Puducherry, South India. J Educ Health Promot. 2019;8:12. doi:10.4103/jehp.jehp_144_18.

Jaideep K, Prashant D, Girija A. Prevalence of high risk among pregnant women attending antenatal clinic in rural field practice area of Jawaharlal Nehru Medical College, Belgavi, Karnataka, India. Int J Comm Med Public Health. 2017;4(4):1257–9.

Hafez SK, Dorgham LS, Sayed S. Profile of high risk pregnancy among Saudi women in Taif-KSA. World J Med Sci. 2014;11(1):90–7.

Macleod J, Rhode R. Retrospective follow-up of maternal deaths and their associated risk factors in a rural district of Tanzania. Trop Med Int Health. 1998;3(2):130–7.

Mohammed M, Al-Saadi M, Kreedy HO, Al-Jindeel TJ, Al-Karawi AS. Causal Relationship Between Rubella Virus Infections and Bad

Obstetric History in Pregnant Women. HIV Nurs. 2023;23(2):5–11.

Ayano B, Amentie B. Assessment of prevalence and risk factors for anemia among pregnant mothers attending ANC clinic at Adama

Hospital Medical Collage. J Gynecol Obstet. 2017;6(3):31–9.

Manjunathachar H, Singh KN, Chouksey V, Kumar R, Sharma RK, Barde PV. Prevalence of torch infections and its associated poor

outcome in high-risk pregnant women of central India: time to think for prevention strategies. Indian J Med Microbiol. 2020;38(3-4):379–

Al-Hakami AM, Paul E, Al-Abed F, Alzoani AA, Shati AA, Assiri MI, et al. Prevalence of toxoplasmosis, rubella, cytomegalovirus, and herpes (TORCH) infections among women attending the antenatal care clinic, maternity hospital in Abha, Southwestern Saudi Arabia. Saudi Med J. 2020;41(7):757–62.

Shweta B, Nupur G, Archana A, Inderjeet G, Suman G, Manisha B, et al. The serological profile of herpes virus amongst patients with bad obstetric history. Apollo Medicine. 2015;12(1):7–10.

AlHamdani MM, Mahdi NK. Toxoplasmosis among women with habitual abortion. EMHJ-East Mediterr Health J. 1997;3(2):310–5.

Jones JL, Dubey J. Foodborne Toxoplasmosis. Clin Infect Dis. 2012;55(6):845–51.

Marsico C, Kimberlin DW. Congenital Cytomegalovirus infection: advances and challenges in diagnosis, prevention and treatment. Ital J Pediatr. 2017;43:38.

Mohammed M, Mousa D, Al-Jindeel TJH, Al-Karawi S. Latent and reactivation Cytomegalovirus (CMV) infection can cause severe fetal sequelae despite pre-conceptional immunity. Bull Natl Inst Health Sci. 2022;140(01):1045.

Abdulkadir A, Gebrehiwot TT. Risk Factors for Rubella Transmission in Kuyu District, Ethiopia, 2018: A Case-Control Study. Interdiscip Perspect Infect Dis. 2019;2019:4719636. doi:10.1155/2019/4719636.

Cao Y, Qiu L, Zhang Q. Study on the relationship between the history of abnormal pregnancy and TORCH infection in pregnant woman. Zhonghua Fu Chan Ke Za Zhi. 1999;34(9):517–20.

Knox AT, Powell SB, Logan LK. Intrauterine herpes simplex virus infection in a monochorionic twin gestation. J Pediatric Infect Dis Soc. 2012;1(2):157–9.

Corey L, Wald A. Maternal and neonatal herpes simplex virus infections. N Engl J Med. 2009;361(14):1376–85.

Aljumaili ZKM, Alsamarai AM, Najem WS. Cytomegalovirus seroprevalence in women with bad obstetric history in Kirkuk, Iraq. J Infect Public Health. 2014;7(4):277–88.

Ciobanu AM, Nicolae G, Corina G, Botezatu R, Furtuna M, Peltecu G, et al. Cytomegalovirus Infection in Pregnancy – Counselling Challenges in the Setting of Generalised Testing. Maedica (Bucur). 2020;15(2):253–7.

Pereira-Chioccola VL, Vidal JE, Su C. Toxoplasma gondii infection and cerebral toxoplasmosis in HIV-infected patients. Future Microbiol. 2009;4(10):1363–79.

Whitley R, Arvin A, Prober C, Corey L, Burchett S, Plotkin S, et al. Predictors of morbidity and mortality in neonates with herpes simplex virus infections. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. N Engl J Med. 1991;324(7):450–4.

Ballal M, Bangar R, Sherine A, Bairy I. Seroprevalance of rubella in BOH cases-A 5 year study. J Obstet Gynecol India. 2007;57(5):407– 9.

Li Z, Yan C, Liu P, Yan R, Feng Z. Prevalence of serum antibodies to TORCH among women before pregnancy or in the early period of pregnancy in Beijing. Clin Chim Acta. 2009;403(1-2):212–5.

Stamos JK, Rowley AH. Timely diagnosis of congenital infections. Pediatr Clin North Am. 1994;41(5):1017–33.

Fung JC, Tilton RC. TORCH serologies and specific IgM antibody determination in acquired and congenital infections. Ann Clin Lab Sci. 1985;15(3):204–11.

Migliucci A, Fraja DD, Sarno L, Acampora E, Mazzarelli LL, Quaglia F. Prenatal diagnosis of congenital rubella infection and ultrasonography: a preliminary study. Minerva Ginecol. 2011;63(6):485–9.

Wang LC, Yan F, Ruan JX, Xiao Y, Yu Y. TORCH screening used appropriately in China?– three years results from a teaching hospital in northwest China. BMC Pregnancy Childbirth. 2019;19(1):484. doi:10.1186/s12884-019-2642-7.

Rasti S, Ghasemi FS, Abdoli A, Piroozmand A, Mousavi SGA, Fakhrie-Kashan Z, et al. ToRCH “co-infections” are associated with increased risk of abortion in pregnant women. Congenit Anom (Kyoto). 2016;56(2):73–8.

Akpan UB, Akpanika CJ, Asibong U, Arogundade K, Nwagbata AE, Etuk S. The Influence of Threatened Miscarriage on Pregnancy Outcomes: A Retrospective Cohort Study in a Nigerian Tertiary Hospital. Cureus. 2022;14(11):e31734.

Lockwood CJ, Krikun G, Rahman M, Caze R, Buchwalder L, Schatz F. The role of decidualization in regulating endometrial hemostasisduring the menstrual cycle, gestation, and in pathological states. Semin Thromb Hemost. 2007;33(1):111–7.

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