Miscarriage and Its Associations

Stephen Brown, M.D.

Disclosures

Semin Reprod Med. 2008;26(5):391-400. 

In This Article

Infectious

Transplacental infections can occur with a variety of organisms, including viruses such as variola, vaccinia, cytomegalovirus, parvovirus, and rubella as well as bacterial organisms such as Brucella, Toxoplasma, Mycoplasma hominis, Chlamydia trachomatis, and Ureaplasma urealyticum. Realistically, there are only a few infections such as Ureaplasma and Chlamydia that one might expect to cause infection of the pregnancy and subsequent loss without causing overt systemic illness in the mother. Surprisingly, there are few studies that have systematically evaluated this possibility. An older study found that Ureaplasma was found more frequently in women with recurrent loss than in controls and that treatment improved pregnancy outcome.[56] More recent literature has not supported this. A study of 54 karyotypically normal miscarriage specimens was tested for the presence of multiple infectious agents by PCR, and only one sample contained Chlamydia DNA, and four contained HPV DNA.[57] There was no evidence for Ureaplasma or other organisms. Another study looked for clinical evidence for infection in a cohort of women and found no difference between those with successful pregnancy and those with miscarriage.[58] Serologic studies have also failed to show evidence of an increased prevalence of chlamydial infection in women with pregnancy loss.[59,60]

In summary, it is clear that known infectious causes are rarely to blame for miscarriage, either sporadic or recurrent; however, if evidence of infection presents itself, it should not be ignored.

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