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by Carolyn Salafia, MD, Ph.D.

Acute infections in pregnancy most commonly refer to bacterial infections. These most commonly arise from the vagina and cross the cervix. For this reason acute infection in commonly also called "ascending infection."

The majority of cases of acute infection that lead to pregnancy loss cause no symptoms in the mother and can only be diagnosed as a cause of loss by examination of the membranes, umbilical cord and placenta under a microscope. Most women and, unfortunately, many obstetricians are not aware that infections can also cause what the doctor "mistakenly" diagnoses as incompetent cervix as well as preterm membrane rupture, uterine contractions and preterm labor. Less commonly the baby can die in utero without much in the way of maternal symptoms at all.

It is very common in cases where a doctor thinks that there is painless cervical dilatation and, therefore, the possibility of an incompetent cervix, that under the microscope I will see evidence of a protracted, long-standing, days old acute inflammation. Infection can weaken and soften connective tissue; a soft cervix may be judged clinically "incompetent" if the doctor does not get the information that an infection was present. If your doctor didn't realize that one of the things that accompanied your cervical dilatation was a longstanding significant infection he may have just stitched you shut and never known he needed to treat an infection. However, if the cervix is opening because it's inflammed by an infection all the stitching in the world isn't going to keep it shut.

It's important to realize that when you get pregnant again that infection won't necessarily be gone. Many infections--whether they are bacteria, yeast, mycoplasma or ureaplasma--are passed back and forth between partners. At the time of testing, some can be present in one partner and not the other. (Unfortunately, when doing a recurrent pregnancy loss workup many obstetricians test only the mother for infection and not the father, thereby missing one source of infection.) If examination of your slides or tissue reveals significant infection in the pregnancy you lost, make sure both you and your partner are treated. When you become pregnant again make sure that you are monitored for future infection.

Some patients wonder why their doctors don't just prescribe antibiotics prophylactically. Physicians are concerned about resistant organisms coming from protracted use of antibiotics. We really feel that clinical monitoring and judgement are extremely important rather than just a chronic ingestion of antibiotics.

Carolyn Salafia, M.D., Ph.D., is board certified in Anatomic and Clinical Pathology and in Pediatric Pathology. She is a world-reknown expert on pregnancy loss and is one of a small handful of pathologists in this country who specialize in reproductive pathology. For more information, see her website, www.earlypath.com. To set up a consultation or have your slides reviewed by Dr. Salafia, you can call her office at 914-834-2598.
Note: This communication is for educational purposes only and should not be used as a substitute for a consultation with your physician.