Erysipelas in pregnancy is rare, but not infrequent after delivery. In the puerperium it appears commonly as a septic infection in abrasions about the parturient canal. When it starts on the face, scalp, or breast the prognosis is relatively favorable, but even then it causes death; when it starts on the genitalia it has a mortality of 43 per cent. Erysipelas causes abortion. As it begins from pus bacteria, it is not seen so frequently now as formerly, owing to greater attention to asepsis. In the puerperium it is often an infection brought on by dirty midwives or physicians.
Malaria, if severe, may interrupt gestation through fever or cachexia. During labor in such cases the uterine action is feeble, and hemorrhages are common after delivery. By proper treatment during pregnancy these evils can be averted. The infection is spread from one malaria patient to another by a mosquito (_Anopheles_), as yellow fever is spread by another mosquito (_Stegomyia fasciata_).
Pulmonary tuberculosis in pregnancy is somewhat frequent; the estimate is that about 32,000 tubercular women become pregnant annually in the United States; and obstetricians incline to the opinion that pregnancy commonly, though not always, makes the tuberculosis worse. Nearly all agree that the combined effect of pregnancy, the puerperium, and lactation is a grave burden on the consumptive and lowers the power of resistance.
Trembley of the Saranac Lake Sanitarium reported that 63 per cent. of 240 tubercular married women under his observation gave a history which showed that the disease was first recognized during pregnancy or the puerperium. Schauta's clinic found such origins in 29 per cent. Fisberg, Funk, Jacob, Panwitz, and other observers, in a series of 1100 cases, said 39 per cent. of these women thought the disease began during pregnancy or the puerperium.
Some tubercular women during pregnancy give no clinical evidence of an aggravation of the pulmonary disease, but these cases are exceptional. Tubercular women who apparently improve during pregnancy are likely to have a subsequent detrimental reaction. As tubercular cases, however, are prone to show exacerbations even if not pregnant, it is not possible to say that pregnancy is the sole cause of the progressive lesions in particular instances. Where there are no wide or deep areas of infection, there may be no recognizable damage from pregnancy, but advanced and active tuberculosis, with fever or cavity formation, does badly, especially if the throat is involved. The pressure of the enlarged uterus causes dyspnoea; the cough and fever may bring on miscarriage. Miscarriage, however, is rare in tuberculosis; it is more common in cardiac and renal diseases. Bernheim, in a series of 315 tubercular pregnancies, found that abortion occurred in 23 per cent. The later in gestation the tuberculosis becomes florid, the more likely it is that abortion will happen. Conception may take place at any stage of the tuberculosis, although women in the final stage are commonly sterile. Sometimes a woman will give birth to a sound child and die herself of tuberculosis a few days after the parturition.