Septic miscarriage

Definition

• A septic miscarriage is an early pregnancy loss complicated by intrauterine infection; traditionally the term denotes any spontaneous or induced pregnancy loss complicated by infection.

Occurrence & epidemiology

Epidemiology

• It is rare and occurs most often after abortions performed under non-sterile conditions, for example by untrained persons without adequate equipment.

Aetiopathogenesis

Aetiology

• Typical organisms are Escherichia coli, Enterobacter aerogenes, Proteus vulgaris, haemolytic streptococci, staphylococci and anaerobes such as Clostridium perfringens; often more than one organism is involved.
• An incomplete miscarriage can also become secondarily infected through an open cervical os.

Clinical features

Clinical features and complications

• Symptoms typically begin 24 to 48 hours after the abortion and resemble pelvic inflammatory disease with chills, fever, vaginal discharge and often peritonitis, frequently together with signs of threatened or incomplete miscarriage such as bleeding and cervical dilatation.
• Septic shock presents with hypothermia, hypotension, oliguria and respiratory distress; sepsis due to Clostridium perfringens can cause thrombocytopenia and intravascular haemolysis with anaemia, jaundice and haemoglobinuria.
• Severe, otherwise unexplained abdominal pain with peritonitis suggests uterine perforation.

Diagnosis

• The diagnosis is usually clinically obvious: signs of severe infection in a woman who is or recently was pregnant.
• Ultrasound looks for retained products of conception; it is insensitive for detecting perforation.
• Laboratory work-up includes aerobic and anaerobic blood cultures, a full blood count with differential, liver and renal function tests, electrolytes and glucose; products of conception are sent for microbiology.

Keep learning in the app

Further reading (selection)

1. StatPearls: Early Pregnancy Loss (Spontaneous Abortion) (NCBI Bookshelf)
2. MSD Manual Professional Edition: Septic Abortion

Cross-references