Friday, December 5, 2008

Lyme Disease and Still Births

O30 - Stillbirth and infection

Robert L GoldenbergDepartment of Obstetrics & Gynecology, Drexel University College of Medicine, Philadelphia,

USAStillbirths (SB) account for more than half the perinatal mortality in most settings world-wide with rates ranging from 3-5/1000 births in developed countries to 20 to nearly 100/1000 births in some developing countries. Infection likely accounts for about 15% of SB in developed countries to 50% in developing countries. Infection is more strongly associated with early gestational age SB than with late preterm or term SB. There are many mechanisms by which infection may cause SB ranging from 1) severe systemic infection of the mother without fetal involvement, to 2) placental infection, to 3) infections of the fetus causing congenital anomalies, to 4) infections of the fetus causing organ failure and death.*

Specific infections that are causally associated with SB include malaria, syphilis, Lyme disease, African tick- bourne gestational relapsing fever, listeria, tularemia and typhoid.* *More important numerically, are the intrauterine infections causing chorioamnionitis, such as placental membrane infections with group B streptococcus, E coli, and the mycoplasmas. Maternal viral infections associated with SB include parvovirus, coxsackie B, varicella, rubella and CMV.* The reasons for the high level of infection - related SB in developing countries likely include environmental pressure from large quantities of urogenital organisms plus poor host defenses likely associated with malnutrition.

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