title: A case of toxic shock due to clandestine abortion by misoprostol self-administration.
abstract: Maternal mortality and morbidity are the leading causes of death and illness, respectively, among women of reproductive age in many countries throughout the world. Of all maternal deaths, those related to unsafe abortions are the most widely underestimated, but they are also the most largely preventable. Medical abortion is a safe and reliable method for termination of a pregnancy in early gestation, although it is important to be aware of signs and symptoms of severe infection and toxic shock syndrome after the medical termination of pregnancy; case studies in literature are rarely fatal events. We report the first case of septic shock syndrome following a clandestine pregnancy termination with a misoprostol-only regimen (12 tablets 200 μg each). Autopsy findings and histopathological examination proved that the woman died from septic shock. This case suggests to improve the forensic investigations in case of unsafe, often clandestine, abortion is suspected.
authors.affiliation: Institute of Forensic Medicine, Catholic University, L.go F. Vito 1, Rome, 00168, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cittadini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Loyola
authors.forename: Letizia
authors.initials: L
authors.lastname: Caradonna
authors.forename: Natalia
authors.initials: N
authors.lastname: Minelli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rossi
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000009:adverse effects*; D000024:Abortion, Illegal; D000328:Adult; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D012651:Self Medication; D012772:Shock, Septic / Q000139:chemically induced*
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: clandestine medical abortion; forensic pathology; forensic science; misoprostol; pregnancy; toxic shock