Saving Mothers' Lives: - Public Health Agency for Northern Ireland

Sepsis in early pregnancy
Six women died of genital tract sepsis occurring before 24 weeks’ completed gestation. One death from
sepsis following illegal abortion is counted and discussed in Chapter 6 - Early pregnancy deaths. Of the
fi ve cases counted here, four were associated with septic miscarriage and one woman died following an
evacuation of her uterus for retained products following a miscarriage. Care was sub-standard in most
cases and the lessons to be learnt from these are summarised in Box 7.1 .
Box 7.1
Learning points: sepsis in early pregnancy
Care should be taken to ensure that the uterus is empty following a surgical evacuation of the uterus. An
ultrasound scan should be performed if there is any doubt.
Screening for infection and antibiotic prophylaxis is recommended in women undergoing surgical
evacuation if there is an increased risk of infection.
Three women had septic miscarriages at around 16 weeks’ gestation. Two of these women were
unbooked. For one of these women this was despite several hospital attendances and two previous
admissions with lower abdominal pain, dysuria and vaginal discharge. No consultant was ever involved
in this woman’s care and the seriousness of her condition was unrecognised until she collapsed, when
inadequate venous access hindered resuscitation. In another case:
A woman attended an Emergency Department (ED) with a four day history of vaginal bleeding,
backache, feeling shivery, vomiting and having fainted twice. She was hypotensive, had a pulse
rate of 146bpm and temperature of 400C. She had not sought antenatal care but thought that she
was about four months pregnant. She was correctly started on intravenous fl uids and antibiotics,
however, her initial, correct, diagnosis of a septic miscarriage was then revised to a probable
ectopic pregnancy despite her pyrexia. As the gynaecologists were occupied in theatres and
could not attend immediately she was transferred to another hospital ill-equipped to treat such
severe sepsis. She died shortly after. All in all she died within three hours of fi rst walking into the
ED. Autopsy showed suppurative chorio-amnionitis from Group A streptococcal infection.
This woman was already critically ill by the time she arrived at hospital and it is extremely unlikely that
different management would have saved her, but the case does illustrate how inappropriate decisions are
sometimes made when hospitals are very busy. Such an ill woman would have been more appropriately
managed in the resuscitation room or critical care unit. An ultrasound scan in the ED would have excluded
ectopic pregnancy. The consultant gynaecologist was available, but not called, until just before she died.
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