TORCH

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TORCH INFECTIONS AND 
PRENATAL ULTRASOUND 
FINDINGS 
Attilio Brisighelli Neto 
Department of Obstetrics and 
Gynecology 
USF – HUSF 
2011 
Limitations 
• Most infected fetuses are sonographically 
normal 
• Ultrasound findings may change with time 
• no correlation with infant outcome 
Cerebral Ventriculomegaly 
• Measured at the posterior aspect of the 
choroid plexus 
• Almost always symmetric 
• 5% of cases can be attributed to fetal 
infection 
Intracranial Calcifications 
• Intrauterine infection 
• Periventricular-cerebral hyperechoic foci 
• Small with no acoustic shadowing 
• Most frequently seen with CMV and 
Toxoplasmosis 
Hydranencephaly 
• Most severe manifestation of the destructive 
process 
• Cerebral hemispheres replaced by fluid, 
brainstem preserved, falx present, absent or 
deviated, posterior fossa structures can be 
identified 
• Reported in Herpes simplex, Toxoplasmosis 
and CMV 
 
Microcephaly 
• Often associated with other CNS anomalies 
• Diagnosed as two or three SD below the 
mean for gestational age 
• Abnormal HC/AC and HC/FL ratios 
• Isolated microcephaly documented in CMV, 
Rubella and Herpes simplex 
Cardiac abnormalities 
• Cardiomegaly, mostly in CMV 
• Cardiothoracic ratio 
• Atrial septal defect (ASD), ventricular septal defect 
(VSD), Pulmonic stenosis and coaractation of the aorta in 
Rubella 
 
Hepatosplenomegaly 
• Documented in all TORCH infection 
• Often a transient finding 
• Normograms are available 
Intra-abdominal Calcifications 
• Typical appearance: echogenic foci with or without 
acoustic shadowing 
• Peritoneum, intestinal lumen, organ parenchyma, 
biliary tree and vascular structures 
• Echogenic bowel in CMV and Toxoplasmosis 
echogenic foci 
Hydrops, Placenta and 
Amniotic fluid 
• Hydrops reported in most TORCH but may 
be transient 
• Placentomegaly is usually associated with 
intrauterine infection, but small placentae 
have also been reported 
• Hydramnios and oligohydramnios have 
been reported with similar frequency 
Fetal growth restriction 
• Estimated weight below the 10th percentile 
• common feature with CMV, Rubella, 
Herpes simplex and Varicella 
• Usually not seen with Toxoplasmosis and 
Syphylis 
TOXOPLASMOSIS 
• 20% - 54% - 65% 
• Ventriculomegaly and cataract are the most 
frequently documented finding 
• Cerebral calcifications, placentomegaly, liver 
calcifications, microcephaly and ascites 
• hyperechoic bowel have been reported 
SYPHILIS 
• Hepatomegaly and Placentomegaly are the 
most frequent sonographic manifestations 
• Fetal growth restriction 
• Ascites, Hydrops and Hydramnios are less 
commonly reported 
• Resolution of sonographic signs have been 
reported with maternal antibiotic therapy 
TRANSMISSÃO VERTICAL 
SÍFILIS CONGÊNITA 
 
75% VDRL + Sífilis primária 
70% a 100% 
transmissão 
 para o feto 
Sífilis secundária 100% VDRL + 90% transmissão 
para o feto 
Latência precoce 
Latência tardia 
VDRL baixo 
VDRL baixo ou – 
Contato sexual 
Sífilis terciária 
30% de 
transmissão 
para o feto 
3 semanas 
6 a 8 semanas 
< 1 ano 
> 1 ano 
RUBELLA 
• Incidence less than 1:100,000 live birth 
• Prenatal diagnosis by sonographic findings have been 
reported 
• Potential detected abnormalities include: cardiac 
anomalies, microcephaly, hepatosplenomegaly, fetal 
growth restriction, microphtalmia and cataract 
• Prevention: Women found to be susceptible during 
pregnancy should be offered vaccination postpartum 
and before discharge from the hospital. Breastfeeding 
is not a contraindication to receiving the rubella 
vaccine 
 
Atrial septal defect (ASD), ventricular septal defect (VSD), Pulmonic 
stenosis, Patent ductus arteriosus (PDA) and coaractation of the aorta 
in Rubella 
Cytomegalovirus 
• The most common congenital infection affecting 1% of 
all live births 
• Intrauterine transmission of CMV takes place in 
approximately 40% of infections 
• 10% of infected neonates demonstrate clinical 
manifestations that potentially could be identified by 
prenatal sonography 
• Ventriculomegaly, fetal growth restriction, Intracranial 
calcifications and oligohydramnios are the most 
frequently reported findings 
 
 
calcificações 
porencefalia 
HERPES SIMPLEX 
• Neonatal herpes simplex virus (HSV) infection can be acquired in 
utero, during vaginal delivery or after birth - HSV are usually 
acquired at birth 
• HSV infections occur in one to six newborns per 10,000 deliveries 
per year 
• The risk of vertical transmission is about 40% to 50% for primary 
infections and about 5% for recurrent infections 
• Approximately 60% to 80% of infants with HSV infections are born 
to women who are asymptomatic at the time of delivery and who 
have no history of genital herpes 
• Hydranencephaly, microcephaly, intracranial calcifications and FGR 
are potentially detectable 
 
hidroanencefalia 
 
SUMMARY 
 • Sonography is not a sensetive test for 
fetal infection 
• Normal fetal anatomy survey cannot 
predict a favorable outcome 
• Multiple organ systems are affected in 
50% of cases 
 
THANK YOU FOR 
YOUR 
ATTENTION 
References 
MORON, Antonio Fernandes. Medicina fetal na pratica obstetrica. 
São Paulo: Livraria Santos, 2003. 352 p. ISBN 85-7288-353-3 
 
MONTELEONE, Pedro Paulo Roque; VALENTE, Carlos Alberto. 
Infectologia em ginecologia e obstetricia. São Paulo: Atheneu, 1998. 
384 p.