Was a UTI responsible for the extreme premature birth? (special case)

My partner and I became pregnant last year, with an expecting date of May 5th (just gone). Unfortunately we lost our little bundle of joy at 22 weeks. I'd like to get some feedback as to whether the loss occurred with a UTI as the likely cause, or if other factors at stake were the likely contributors. The death certificate states "extreme prematurity" as the cause with no autopsy having been completed to identify any further findings.

Let me run through the pregnancy and a little history to help set the stage...

7 years ago, my partner was involved in a severe vehicle accident from which she received a plethora of injuries and broken bones. Her pelvis was cracked in multiple places, right leg shattered with 37 pins and multiple plates inserted, damaged skull/face, rupture of internal organs and a host of other injuries. She has suffered from DVTs and has had a number of blood clots which required an IVC filter to stop any clot materials getting to her heart. She still has a main vein blockage that doctors have yet to successfully alleviate. The metal work was removed some weeks prior to the pregnancy due to bone and skin infections beginning to take hold. A heavy course of antibiotics were used and finished, also prior to the pregnancy. The doctors prescribed Warfarin to keep her blood thin enough to avoid further clotting, which had since been replaced with Clexane due to a previous pregnancy. Warfarin is lethal in pregnancy, hence the swap to Clexane. The doctors told her she would never conceive again and if it were possible, the chances of reaching term were extremely unlikely and at majorly high risk of enormous complications. Because of constant throbbing pain, she has been on a steady course of self-prescribed Paracetamol and Codeine tablets for her pain management, sometimes swapping to ibuprofen/codeine (not recommended when on Clexane blood thinners). She has a built up immunity to the codeine and as such, takes considerably more than the recommended doses of codeine based products to achieve the same effect.

My partner's pregnancy history consists of a successful 32 week premature birth 8 years prior (also prior to the accident), a miscarriage, a fairly recent abortion to her ex, and of course our failed pregnancy. The medications she has been on prevent her from using birth control successfully. Tracking her cycle was near impossible as her body would not conform to norms and cycles could vary from 14 days to 2 months - more the former than the latter. Upon our relationship beginning, my partner was unknowingly suffering from acute vaginitis due to the antibiotics completely destroying all the good bacteria in her vaginal operation.

Upon separating from a long term relationship 6 months prior to the beginning of our unity, she began to suffer from anxiety and medium depression. That has escalated over time, with the anxiety beginning to have major effects on her life and employment. She did trial a course of anti-depressants which lead to her nearly losing her job and her mind. She now takes, and has taken un-prescribed diazepam 5mg (Valium) on a regular basis - two per day on average, and continued from the beginning to the end of the pregnancy.

To help flesh out the story, my partner has an addictive background in certain drugs. She is a regular cannabis high volume user (2-3 grams daily). She smokes 40 cigarettes daily. Will consume 1-3 glasses of wine or equivalent spirits on a nightly basis on return from her employment. She takes 10mg of Valium daily. Anywhere from 150-300mg codeine daily depending on her self-analysis of pain. She has been known to dabble in methamphetamines in a non-addictive behaviour (thankfully).

So when we first suspected we were pregnant, she went into a denial phase which balanced on the idea that until she has seen a beating heart on an ultrasound, she would not be convinced that she was pregnant. That did not occur until near 6-7 weeks into the first trimester. During this period she continued to use all the above mentioned drugs and alcohol without any change in dosages. Unfortunately, after the ultrasound was completed and it was clearly evident that there was a live foetus with a beating heart, there was still no change in dosage of all drugs and alcohol mentioned. The personal doctor and the local hospital labelled the pregnancy as high risk from the moment it began and treated it as such throughout the entire cycle. My partner did not admit her personal addictions in fear of being judged or receiving a lesser extent of service.

Throughout the entire pregnancy, my partner suffered constant pregnancy related sickness, manifesting in irregular vomiting and nausea. She complained of pain in her abdominal and lower back areas, with the normal constant pain of her shattered leg added on top. She was extra-ordinarily tired throughout the pregnancy also (not an over statement as I have witnessed 4 previous successful pregnancies with my own children of prior relationships).

Being that her diet was dismal to say the least, she began to take vitamin supplements in the form of Blackomores Pregnancy and Breast Feeding Gold tablets, 10mg iron tablets, Swisse Women’s Ultivite tablets and probiotic capsules (to control the vaginitis).

During the pregnancy, it should also be known that there were numerous relationship issues which increased stress, anxiety, and exhaustion. Numerous other family issues were prevalent and further added to the already stressful environment. It was the least ideal environment for any woman to have support a pregnancy.

Numerous ultrasounds were performed throughout the pregnancy, with all results pointing towards a healthy baby. Correct size and weight readings when compared to averages all throughout the 2 trimesters. Nuchal scan was completed with successful/satisfactory results.

Fast-forward to the final days of the pregnancy…

Two days prior to the unexpected complications, my partner was very concerned with her pain levels and suggested we go to the hospital to monitor the situation. She was admitted into emergency and our downward spiral adventure began.

They took blood and urine and performed numerous examinations both internal and external. My partner was experiencing Braxton-hicks contractions at 7-10 min intervals. The following day, another urine test needed to be taken as the results of the previous test were tainted. An ultrasound was also performed however it was incomplete as the appendix was unable to be identified as ‘normal’ – this was an issue as external pressure tests suggested a possibility of appendicitis. An MRI was suggested and scheduled for the next available opportunity (turned out to be late that afternoon as luck would have it). That evening it was suggested that a UTI was in play from the results of the successful clean catch on the second urine test. They flushed her system with IV targeted antibiotics to attack the infection and kept her in ‘short stay’ for further monitoring. The head of the paediatrics department was not convinced that the UTI was the cause of the pain and suggested we talk to the hospital surgeon general for further investigation and consultancy. A steady dose of 5mg oxycodone (morphine) tablets were prescribed and delivered on schedule by nurses throughout the night and day.

Next morning we saw the surgeon general with the results of the previous evening’s MRI scan. She was also not convinced that a UTI could be the sole underlying issue. She examined the MRI results and cleared the appendix and all other visible organs, placenta and foetus as healthy. Another IV flush of antibiotics was completed. At this point, the pain had not decreased or increased, nor changed location. The doctors said we could remain in for monitoring or we could go home, provided she was forcefully rested and monitored (obviously by me). We took the home option as she was already infuriated by having to stay at the hospital as long as she had – her hospital history is large and she doesn’t bode well when confined to a hospital bed.

The doctor provided a prescription of the oxycodone tablets, a reduced level of Clexane supply, and a course of antibiotics for the UTI. We left at 7pm that day and collected the prescriptions immediately. During the drive, she alerted me to every bump on the road coinciding with heavy pain in the aforementioned areas.

We arrived home and I prepared the bed with every pillow and blanket in the house. Gave her all required doses of tablets and setup the tv and media centre for a few days of movies and rest. Everything seemed ok until out of the blue and without any related physical movement, her waters broke aggressively with a high pressure release causing her to go into psychological shock as she attempted to clean herself up. I assisted as much as I could, given the volatility of the situation. I spoke to the maternity ward staff who advised us to immediately return to the hospital for investigation. It took near an hour for my partner to settle out of an anxiety attack before I could safely transport her back to the hospital.

Upon arrival, more tests were done – bloods, urine, internal and external tests. The foetus was still alive and had a healthy beating heart, although staff were obviously highly concerned with the waters breaking and the duration of the pregnancy being only estimated at 22 weeks. The kept us in and continued to monitor the situation. The head of paediatrics visited us again and this time, the news was not so good. He advised that there was a chance we could manage the pregnancy with drugs (stop the body going into labour) and begin a steroid treatment at 25 weeks to assist foetal lung development in preparation for a very premature birth.

Unfortunately, about 6 hours later, the effects of the body’s natural induction of labour began to show when the umbilical cord made a 2 inch showing outside of the vagina. It was at this point that we knew it was all over.

Without going into great detail, my partner chose to deliver naturally with the assistance of IV delivered synthetic induction (synthetic oxytocin). A six hour labour with 308mg of IV delivered morphine and a very upsetting delivery. She was taken off for a D&C (cleaning of the uterus) which was apparently successful. The hospital gave her lactation suppression tablets to dry up her breast milk and advised of all health and counselling services.

She since went into complete denial of the excessive drug and alcohol usage leading into the premature birth, choosing to only identify with the UTI being the cause of the tragedy. We chose not to have an autopsy as I felt that doing so would protect her from being exposed for the prescribed and non-prescribed drug and alcohol usage being the contributor to the failure.

If you have read all of this so far, I would like to firstly say thank you for taking the time to do so, and thanks in advance if you would be kind enough to add your feedback as to whether it should be assumed that the UTI was the cause of the premature birth, or if any/all of the lead-in factors were likely to be the contributing factors and the UTI was just a regular pregnancy occurrence as it is in over 50% of successful pregnancies worldwide.

PS: I did research each of the drugs mentioned and their effects on pregnancy. I also researched drug interactions of multiple drugs which revealed some less than exciting information, especially in regard to interactions and pregnancy.

Personally, I think a combination of the Clexane in the blood reducing the volume of oxygen to the uterus and foetus. Compound that with the oxygen thinning caused by smoking of cigarettes. Again compound that with Valium and excessive codeine which imbalances the body’s ability to manage and maintain systems responsible for successful foetal growth.

It is an easily researchable fact from many reliable sources that UTIs are present in over 50% of successful, full and less than full term pregnancies where the child is born with absolutely no complications and the mother being completely unaware of the UTI throughout the entire pregnancy.

Anyhow, I would love to know your thoughts, positive, negative or otherwise.

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