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Pregnancy

Rubella pregnancy risk

06/23/2008

Question:

Dear doctor, 

I lost my pregnancy in third trimester (eighth month). It was a still birth (IUD). At the time of IUD, the baby weight was 500 grams only.The baby was grown up to 5 months very well. After that there is no growth at all. We investigated the cause of death with baby biopsy. The results showed placental fractures with no congenital abnormalities. After 1.5 years, myself and my husband went for laboratory analysis.

Myself: TORCH, VDRL, RBS and Anti-phospholipid antibody titers-IgG and IgM. The results were: VDRL- Non reactive (myself & my husband). Blood sugar (fasting)-89% (range 60-110 mg%). Anti- phospholipid antibody titer-IgG-7.21 U/ml (range more than 15 U/ml positive) Anti-phospholipid antibody titer-IgM-4.80 U/ml (range more than 15 U/ml positive). Rubella IgG-326.6 IU/ml (Range >10 IU/ml positive) Cytomegalo Virus IgG- > 250 AU/ml(Range->15 AU/ml- positive). HSV1 IgG-3.61 Index value(Range>1.2 index value Positive)

Remaining test results were within normal limits (Toxoplasma IgG, IgM, Rubella IgM, Cytomegalo Virus IgM, HSV1 IgM, HSV2 IgG, HSV2 IgM).

I was consulted gynecologist and now Ii started Rovastatin for daily 2 weeks for 5 weeks.

Could you please explain the reason of IUD and treatment, precautions for next pregnancy. Is there any treatment for my problem? Is there any problem for next pregnancy?

For next pregnancy purpose, how long should we wait? I hope your site will be helpful for my problem.

Answer:

There are few things in life as sad and upsetting as experiencing a stillbirth, and I am very sorry for your loss.

Stillbirth, or intrauterine fetal demise, can occur due to several medical and environmental factors. For example, the fetus can die from an infection, a genetic abnormality, a structural abnormality, not getting enough blood flow (e.g. if something is wrong with the umbilical cord or placenta), toxic exposure, a maternal medical condition, or insufficient nutrition. And this is still only a partial list.

It sounds as though you have had testing done that would rule out many of the problems listed above. The common infections that can cross the placenta to a developing fetus are often called TORCH because they include toxoplasmosis, syphilis (Other), rubella, cytomegalovirus and herpes. These infections only cause a problem when the infection occurs during pregnancy, and your tests indicate a past exposure, but not necessarily an infection during pregnancy (which would cause an increase in IgM titers during pregnancy). Therefore, I cannot provide you with a reason for your loss from the information given.

Often a thorough workup still fails to identify a reason, and for a woman who is healthy and not subject to a toxic environment, the chance of such an event recurring is low. When you are emotionally and physically recovered from this pregnancy, you may try to get pregnant again and get prenatal care early. You will probably need to have more intensive surveillance during your next pregnancy to detect any possible problems as early as possible.

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Response by:

Jonathan  A Schaffir, MD Jonathan A Schaffir, MD
Clnical Assistant Professor of Obstetrics & Gynecology
College of Medicine
The Ohio State University