Re: Management of Isolated Abnormal Amniotic Fluid Volume in Pregnancy: Time to Retire <scp>TORCH</scp> : An Outdated Test in Modern Obstetric Practice

I congratulate the authors on addressing this important topic in their article [1]. However, I believe that the continued discussion of TORCH screening in cases of polyhydramnios and oligohydramnios reflects an outdated practice that should have been abandoned decades ago. As early as 2005, Abdel-Fattah et al. [2] demonstrated that routine TORCH screening is unnecessary, with only targeted CMV testing showing potential relevance. A later systematic review in 2022 by Fitzpatrick et al. [3], which included eight studies and 2538 pregnancies, concluded that the diagnostic yield of TORCH serology for non-specific ultrasound findings such as isolated fetal growth restriction (FGR) or polyhydramnios is extremely low. Notably, no confirmed cases of congenital toxoplasmosis, rubella or HSV were identified, and CMV infection was largely associated with multiple fetal anomalies rather than isolated findings. A more recent study by Shqara et al. [4] that included 771 women and a two-centre study from Australia that reviewed 718 pregnancies, representing 760 fetuses, [5] also consistently demonstrate that routine TORCH screening in isolated FGR, polyhydramnios or oligohydramnios provides no meaningful diagnostic benefit. Testing should therefore be limited to targeted CMV or toxoplasma investigations, and only in the presence of maternal symptoms or specific fetal sonographic features. Furthermore, emerging evidence [6] challenges the assumption that isolated findings, such as fetal echogenic bowel, should automatically prompt TORCH testing. In this context, the proposed flow chart 1 suggesting TORCH testing as a parallel investigation to ultrasound assessment is difficult to justify. Instead, positive imaging findings should guide targeted testing, primarily for CMV. In the light of this robust and consistent evidence, full TORCH screening is now obsolete, and it is timely for any guidance from RCOG platform to formally move away from long-standing but unsupported clinical practice.