Death as a result of infection during miscarriage rare

Dr. Muiris Houston, writing in the Irish Times. Article on the Times' website here. 

Background: A death as a result of an infection during a miscarriage is a rare event in the developed world. Referred to as a septic abortion or miscarriage, most cases are due to infection with bacteria such asE.coli or streptococci.

In a more severe form that spreads to the wall of the uterus, the patient will usually have a fever and a raised pulse.

The initial management of a suspected septic abortion involves taking a swab from the vagina and the neck of the womb. If the woman’s temperature goes above 38.4 degrees Celsius then blood is taken and sent to the laboratory to see if the bugs have spread to the bloodstream.

A combination of antibiotics is started even before the results of these tests are available. However, it is possible that despite the treatment the patient will go into medical shock, their blood pressure drops and a serious complication called disseminated intravascular coagulation (DIC) may ensue.

In this situation it is normal practice to wait until the patient has stabilised before surgically removing the contents of the uterus.

On rare occasions, a hysterectomy may be needed if the infection remains uncontrolled.

A miscarriage is defined as loss of pregnancy in first 24 weeks of gestation.

There are different types of miscarriage including:

* a threatened miscarriage with mild symptoms of bleeding and usually little or no pain. The neck of the womb remains closed;

* an incomplete miscarriage occurs if either the conception sac or the placenta remains in the womb;

* an inevitable miscarriage occurs with heavy bleeding, and the neck of the womb is now open. If the bleeding is severe the mother may slip into medical shock.

In an inevitable miscarriage, even though a foetal heart beat is present, the pregnancy cannot continue to term.

With the neck of the womb already open, the woman’s body prepares to naturally evacuate her womb.

However, with the neck of the womb open, there is an opportunity for bugs such as E.coli to travel from the vagina into the womb before multiplying and infecting the inside wall of the uterus.

Infection can then spread to the woman’s bloodstream, leading to shock and the onset of DIC, which occurs when the normal functioning of blood cells is progressively impaired, leading to multi-organ failure.