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What kinds of infections can lead to early miscarriages?

Dr Shirish Kumar
Haematologist,
WHO,
Geneva

Q: I have suffered two miscarriage within one month of the confirmation of pregnancy. This has happened within 2 years of marriage. I am 27 yeras old with no issue. Reports indicate viral infection. Does infection have so much effect and cause miscarriage? Can infection of pre or post pregnancy period be rectified? What can be done to prevent infection? Can all types of infection harm pregnancy? What can be done to nullify its ill effect? How can infection be detected at an early stage?

A:Early pregnancy loss is defined as the termination of pregnancy before 20 weeks gestation or below a fetal weight of 500 grams. It is the most common complication of human gestation, occurring in at least 75% of all women trying to conceive. Most of these losses are unrecognized and occur before or with the next expected menses. Of those that are recognized, 15-20% are spontaneous abortions or ectopic pregnancies diagnosed after clinical recognition of pregnancy. Approximately 5% of couples trying to conceive have 2 consecutive miscarriages, and approximately 1% of couples have 3 or more consecutive losses. The etiology (cause) of early pregnancy loss is varied and often controversial. More than one etiologic factor is often present. The most common causes of recurrent miscarriages are as follows: Genetic abnormalities in the embryo (50%), Congenital malformations, Immune causes, Hormonal causes, Infections, etc.Although infection has been cited as a cause of pregnancy loss, few studies exist and results are inconsistent. Numerous organisms have been implicated in the sporadic cause of miscarriage, but common microbial causes generally have not been confirmed. In fact, infection is viewed as a rare cause of recurrent miscarriage. Those organisms implicated include the following: Bacteria (Listeria monocytogenes, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Bacterial vaginosis); Viruses (Cytomegalovirus, Rubella, Herpes simplex virus, Human immunodeficiency virus, Parvovirus); Parasites (Toxoplasma gondii, Plasmodium falciparum, Spirochetes - Treponema pallidum).The most obvious risk situation in recurrent abortions is related to the following: Gonorrheal infection, Chlamydia, bacterial vaginosis, genital mycoplasma, Listeria monocytogenes, Syphilis, Borreliosis, Viral infections like CMV, HSV, HIV, Malaria and Toxoplasmosis.