Treatment Approach for TORCH Infections in Recurrent Abortions

Toxoplasmosis Management

The American College of Obstetricians and Gynecologists recommends serologic testing for Toxoplasma IgG antibody in women with recurrent abortions to determine infection status 1
Pregnant women who have evidence of primary toxoplasmic infection or active toxoplasmosis should be evaluated in consultation with appropriate specialists, as recommended by the Centers for Disease Control and Prevention 1, 2
Infants born to women with serologic evidence of toxoplasmosis should be evaluated for congenital toxoplasmosis, according to the Centers for Disease Control and Prevention 1, 2
Spiramycin (1g or 3 million IU orally three times daily) is the first-line treatment for suspected or confirmed infection before 18 weeks gestation, as recommended by the American College of Obstetricians and Gynecologists 1
Pyrimethamine plus sulfadiazine plus folinic acid is recommended for suspected or confirmed infection at or after 18 weeks gestation, when amniotic fluid PCR is positive for T. gondii, or when abnormal fetal ultrasound findings suggestive of congenital toxoplasmosis are present, according to the American College of Obstetricians and Gynecologists 1
For HIV-infected pregnant women, TMP-SMZ can be administered for prophylaxis against toxoplasmosis, as recommended by the Centers for Disease Control and Prevention 1, 2

The American College of Obstetricians and Gynecologists recommends antiviral therapy during pregnancy for women with primary HSV infection or severe herpes infection 3
Acyclovir appears to have no increased risk for major birth defects after prenatal exposure, according to the American College of Obstetricians and Gynecologists 3
For women with history of genital herpes, antiviral prophylaxis in the third trimester can reduce the risk of recurrence at delivery, as recommended by the American College of Obstetricians and Gynecologists 3

Prevention strategies should be emphasized, including hand hygiene, avoiding undercooked meat, and vaccination when available, as recommended by the American College of Obstetricians and Gynecologists 1

Regular ultrasound monitoring is essential for pregnant women with confirmed TORCH infections, according to the American College of Obstetricians and Gynecologists 1
Amniocentesis with PCR testing may be considered to determine fetal infection status, particularly for toxoplasmosis, as recommended by the American College of Obstetricians and Gynecologists 1
Neonatal evaluation is crucial for infants born to mothers with TORCH infections, according to the Centers for Disease Control and Prevention 1, 2