Septic Abortion (Infected Miscarriage)

Causes

Septic abortion usually develops when pregnancy tissue (retained products of conception) remains in the uterus, providing a place for bacteria to grow. Bacteria typically come from the vagina and cervix and include:

• E. coli and other gut bacteria
• group A and group B streptococci
• anaerobic bacteria
• Staphylococcus aureus
• Clostridium species (rare but very dangerous)
• sexually transmitted organisms such as chlamydia and gonorrhea

Risk factors

• incomplete miscarriage or abortion with retained tissue
• unsafe abortion performed by untrained people or with unsterile instruments; a leading cause of maternal death worldwide where safe abortion care is unavailable
• untreated sexually transmitted infection or bacterial vaginosis
• uterine injury or perforation during a procedure
• delayed care after pregnancy loss
• miscarriage in the second trimester

Infection after legal abortion performed by trained providers in a medical setting is uncommon.

Symptoms

Symptoms usually begin within days after the miscarriage or procedure:

• fever and chills
• lower abdominal or pelvic pain and cramping
• heavy, prolonged or irregular vaginal bleeding
• foul-smelling vaginal discharge
• pain during a pelvic exam, with an enlarged tender uterus
• nausea and vomiting

Signs of sepsis

• fast heart rate and fast breathing
• low blood pressure, dizziness or fainting
• confusion
• cold, pale or mottled skin
• little or no urine

Diagnosis

• examination: temperature, pulse, blood pressure; pelvic exam
• blood tests: blood count, inflammatory markers, kidney and liver function, lactate, clotting tests, blood cultures
• pregnancy hormone (hCG) level
• swabs from the cervix for culture and STIs
• pelvic ultrasound to look for retained tissue, abscess or perforation
• CT scan if perforation or abscess is suspected

Treatment

Treatment begins immediately, often in an emergency department:

1. IV fluids and oxygen; treatment for shock if present
2. broad-spectrum IV antibiotics covering gut, vaginal and anaerobic bacteria, started within an hour of recognizing sepsis
3. uterine evacuation (suction aspiration, also called D&C) to remove infected tissue, usually within hours of starting antibiotics
4. surgery if there is uterine perforation, abscess, or infection that does not respond, rarely including hysterectomy
5. intensive care for septic shock or organ failure
6. Rh immune globulin if Rh-negative

Complications

• sepsis and septic shock
• disseminated intravascular coagulation (abnormal clotting and bleeding)
• kidney failure and acute respiratory distress syndrome
• pelvic abscess
• uterine scarring (Asherman syndrome), tubal damage and infertility
• death if untreated

Recovery and future pregnancy

With prompt treatment, most people recover fully. Follow-up checks confirm the infection has cleared. Many people go on to have healthy pregnancies, although severe infection can affect future fertility. Emotional support after pregnancy loss is important; counseling and support groups can help.

Prevention

• access to safe, legal abortion care and timely miscarriage management
• seeking care promptly for bleeding or pain after a pregnancy loss
• STI screening and treatment
• follow-up after miscarriage or abortion to confirm the uterus is empty

Frequently asked questions

What is a septic abortion?

It is a uterine infection that occurs during or after a miscarriage or abortion, usually from infected pregnancy tissue left in the uterus. In medical language, "abortion" includes miscarriage. It can lead to sepsis and needs emergency treatment.

What are the signs of infection after a miscarriage?

Warning signs are fever or chills, worsening lower belly pain, heavy or prolonged bleeding, and foul-smelling vaginal discharge. Feeling faint, confused or having a racing heart can signal sepsis. Seek emergency care immediately if these occur.

How is septic abortion treated?

Treatment involves IV fluids, broad-spectrum IV antibiotics and prompt removal of any remaining tissue from the uterus. Severe cases may need intensive care or surgery. Starting treatment quickly is essential.

Can you get pregnant after a septic abortion?

Yes, most people can. Prompt treatment lowers the risk of lasting damage. Severe or delayed infection can cause scarring of the uterus or fallopian tubes that affects fertility, so follow-up care is important.