Fatal clostridial sepsis after spontaneous abortion.
BACKGROUND
Although obstetric mortality due to complications of Clostridium perfringens infection is rare at present, we report a case of fatal clostridial sepsis secondary to a septic spontaneous abortion.


METHODS
A woman at 6-8 weeks' gestation presented with vaginal bleeding and abdominal pain. Although afebrile, the patient was hypotensive, tachycardic, and tachypneic. Physical examination was remarkable for a 10-weeks'-gestation-size uterus, mild pelvic tenderness, a closed cervix without signs of trauma, and moderate vaginal bleeding. Laboratory studies were consistent with infection, hemolysis, and coagulopathy. Sonography demonstrated echolucencies consistent with gas formation in the endometrial cavity. Despite fluid resuscitation, transfusions, antibiotic therapy, and a dilation and curettage, persistent vaginal bleeding required an emergency hysterectomy. Hypotension ensued, and despite aggressive resuscitation attempts, the patient died.


CONCLUSIONS
Rare cases of fatal sepsis secondary to pelvic infection with Clostridium perfringens continue to occur. Hemolysis, anuria, coagulopathy, and characteristic sonographic findings should heighten suspicion of this potentially fatal infection.
Barrett
John P
JP
Department of Obstetrics and Gynecology, Women and Infants' Hospital of Rhode Island, Brown University School of Medicine, Providence, Rhode Island, USA.
Whiteside
James L
JL
Boardman
Lori A
LA
D000031:Abortion, Septic / Q000503:physiopathology*; D000022:Abortion, Spontaneous / Q000382:microbiology*; D003015:Clostridium Infections / Q000503:physiopathology*; D003016:Clostridium perfringens; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D018805:Sepsis / Q000503:physiopathology*