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Why do I have stillbirths?

Q: I am a 24 years old woman who had two stillbirths, occurring with severe oligohydramnios. After the second stillbirth at 28 weeks of the pregnancy, I was tested for toxoplasmosis using the ELFA method. The IgG antibody level was positive (157 ui/ml) while IgM antibody level was negative (0.14 ui/ml). Is it possible that the high level IgG could be the cause of the fetus death? During the pregnancy, I had fear, anxiety and high blood pressure problem.

A:Toxoplasmosis can cause an occasional pregnancy loss (in most cases it causes neonatal problems and that too only if acute active infection occurs during early pregnancy) but almost never recurrent late pregnancy loss. Toxoplasmosis is a once a lifetime infection and unless a woman has problems with her immune system like AIDS and similar diseases, it can never infect the same person twice. It is a relatively minor infection and only causes problems if it occurs in pregnancy. Well since your IgG and not IgM is positive you are safe, and can never get re-infected if your immunity is ok. IgG stays in your body for decades, practically a lifetime, and will protect you from this infection. So you can be reasonable sure that you did not lose both your pregnancies because of Toxoplasmosis, as it is not a cause or recurrent pregnancy loss. Either way one thing is for sure that you will not have toxoplasmosis in your life again. Now the question is why did you lose your pregnancies. Since this question cannot be answered in absence of autopsy reports, and other tests on the stillborn fetus, women who lose babies are made to undergo a battery of tests, which seldom yield answers. Toxoplasmosis is one such test. It is frequently blamed for the abortion. At the risk of making a hazardous clinical guess, with the information provided by you, all I can say at this stage is that the only problem you had was pregnancy-induced hypertension (PIH). Everything fits in with the diagnosis of severe PIH, especially if it was associated with proteins in the urine. This would cause severe growth restriction and Oligohydramnios. (In Congenital toxoplasmosis you are more likely to have a swollen up fetus with Polyhydramnios – or too much water, rather than oligo-hydramnios, though oligo-hydramnios and severe growth restriction is not impossible if the toxoplasmosis infection was early enough). Either way, Toxoplasmosis could not cause 2 stillbirths, though PIH can and sometimes does. PIH unfortunately also tends to recur and you may have similar problems in your subsequent pregnancies. The reassuring fact however is that by and large pregnancy induced hypertension improves with each pregnancy and your later pregnancy would have no PIH or a much milder form. This should and can be managed. If any tests are required, you need tests for what is known as APLS (Anti-Phosphlipid Syndrome, a serious problem and with expert care and extensive treatment you can hope to have a normal pregnancy). Tests like Anticardiolipn A and Lupus Anticoagulant can rule this out and if that is negative you do not need to worry too much (I am sure you would have been tested for them by now). You also need genetic counseling by an expert geneticist. Besides I am sure they would have ruled out liver and kidney diseases for you. I know it is terrible to go through such a tragedy twice and nothing I say or do will ease your pain but a subsequent normal pregnancy and a healthy baby, will give you the strength to cope with this pain. You should not be disheartened, and please plan a pregnancy as soon as you are emotionally ready. In the meantime you seem to be a little overweight and losing some weight will help your next pregnancy a lot. You should be positive about your next pregnancy. If you are as scared as you sound and try to get treatment to have a healthy baby, you may be offered treatments like low dose aspirin, various hormones and worse still dangerous treatments like Heparin and LITT therapy. While some have use in specific one in a thousand case, by and large these are a host of unscientific irrational and hazardous treatments of unproven benefit. Indeed many complications occur because of these. The only reason these are given is that something must be done. So please do not seek or accept any treatment without medial logic and proven benefit, and if indeed no cause of your still births are found and you do not develop hypertension in your next pregnancy, and you do not have APLS, you do not need any treatment, just leave things to nature and I am sure all would be ok.

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