Avoid Sepsis After Miscarriage

Having a miscarriage is often a devastating event. For about 2% of women, the experience becomes even more distressing when tissue that was not fully expelled by the uterus becomes infected.

In the worst cases, the infection will become septic, causing what is known as a septic miscarriage or septic abortion. Since sepsis is a potentially life-threatening condition, it's critical to know the symptoms and get medical treatment as soon as possible.

symptoms of sepsis after miscarriage
Verywell / Gary Ferster

Causes of Infection

Infections are a risk after any miscarriage or non-therapeutic abortion (an abortion for non-medical reasons). Gynecological and obstetric surgeries can also put a woman at risk of infection.

When tissue from pregnancy remains in the uterus after a miscarriage or abortion, it can serve as a breeding ground for bacteria, including:

  • E. Coli
  • Prevotella
  • Bacteroides
  • C. trachomatis
  • Group B streptococci
  • Enterobacteriaceae

Infections caused by these bacteria can be progressive, meaning that they begin in the uterus and, if left untreated, can progress to the bloodstream and infect the entire system, leading to septic shock. With septic shock, blood pressure drops dangerously low, starving the organs of their blood supply. This can ultimately result in organ failure.

Reduce the risk of infection after a miscarriage by avoiding sexual intercourse, swimming pools, douching, and tampons for the amount of time recommended by your physician.

Women with congestive heart failure, liver disease, renal disease, or lupus have a higher risk of developing infections after pregnancy. Women who undergo invasive procedures to treat infertility or during pregnancy may also have an increased risk of uterine infection.

Symptoms

Bacterial infections can spread and become septic quickly, so if you have any of the following symptoms after a miscarriage, contact your doctor immediately or go to the emergency room:

  • Prolonged bleeding and cramping (longer than about two weeks)
  • Fever over 100.4 degrees
  • Chills
  • Foul-smelling vaginal discharge
  • Pelvic pain
  • Tenderness in the uterus
  • Unusual drowsiness

Diagnosis

If you have symptoms of an infection after a miscarriage, your doctor will perform an ultrasound to look for retained tissue in the uterus. An MRI or CT scan can also be used for this reason. Your doctor will also check your blood pressure (which drops during sepsis), your heart rate (which goes up), and your oxygen saturation levels (which decrease).

Your physician will also do blood tests that can indicate the presence of bacteria in the bloodstream. These indicators include:

  • High white blood cell count
  • Immature white blood cells in circulation
  • Elevated plasma C-reactive protein
  • Elevated procalcitonin (PCT)
  • High creatinine levels
  • Low platelet levels
  • High bilirubin levels
  • High lactate levels

Sometimes, women with septic miscarriage have a history of ob/gyn surgery or non-therapeutic abortion. It's important that you disclose all relevant information to your healthcare provider. Remember that the vast majority of physicians are compassionate and nonjudgmental.

Treatment

If you have tissue remaining in your uterus, your physician will perform a surgical procedure called dilation and curettage (D&C) in which the cervix is dilated and the tissue removed with a tool called a curette (or in some cases, a vacuum-like device).

If your infection has become septic, urgent treatment is necessary and you will be sent to the hospital and monitored closely. You'll be given intravenous fluids to increase blood volume and blood pressure as well as intravenous broad-spectrum antibiotics, which kill a wide variety of bacteria.

Your blood will be cultured in order to identify the specific bacteria causing the infection. Once it's identified, which can take a few days, you will be given an antibiotic that is tailored to the bacteria causing your infection. Once your condition has stabilized, you will be sent home and will likely need to take oral antibiotics for a few days or weeks.

In rare cases, the infection in the uterus cannot be cured, and a hysterectomy is needed to save the life of the patient. In most cases, however, an infection after a miscarriage, even if it turns septic, is curable and is unlikely to affect future pregnancies.

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Article Sources
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  1. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Early Pregnancy Loss. Updated November 2018.

  2. Sharma H, Tal R, Clark NA, Segars JH. Microbiota and pelvic inflammatory disease. Semin Reprod Med. 2014;32(1):43-49. doi:10.1055/s-0033-1361822

  3. Bauer ME, Bateman BT, Bauer ST, Shanks AM, Mhyre JM. Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis. Anesth Analg. 2013;117(4):944-950. doi:10.1213/ANE.0b013e3182a009c3

  4. Centers for Disease Control and Prevention. How is sepsis diagnosed and treated?. Updated June 27, 2018.

  5. Fan SL, Miller NS, Lee J, Remick DG. Diagnosing sepsis - The role of laboratory medicine. Clin Chim Acta. 2016;460:203-210. doi:10.1016/j.cca.2016.07.002

Additional Reading
  • Sepsis Alliance. Pregnancy and childbirth. Updated December 14, 2017.

  • Tucker R, Platt M. Chapter 38. Obstetric and Gynecological Emergencies and Rape. In: Stone C, Humphries RL. eds. CURRENT Diagnosis & Treatment Emergency Medicine, 7e. McGraw-Hill; 2011. 

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