misoprostol and Disseminated-Intravascular-Coagulation

A 32-year-old multigravid patient at 21 weeks gestation presents with major concealed placental abruption and subsequent fetal demise. During an eventually failed misoprostol regime aiming for vaginal delivery she develops severe disseminated intravascular coagulopathy. Subsequent hysterotomy reveals Couvelaire uterus with major haemorrhage and requires subtotal hysterectomy for haemostasis. This case highlights the severity of the systemic response to abruption and fetal demise in utero and the multifactorial nature of its management.

Topics: Abortifacient Agents; Abruptio Placentae; Adult; Diagnosis, Differential; Disseminated Intravascular Coagulation; Female; Fetal Death; Humans; Hysterectomy; Misoprostol; Pregnancy; Pregnancy Trimester, Second

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.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Criminal; Adult; Disseminated Intravascular Coagulation; Fatal Outcome; Female; Humans; Misoprostol; Pregnancy; Self Medication; Shock, Septic

Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Contraindications; Delivery, Obstetric; Disseminated Intravascular Coagulation; Female; Fetal Death; Fetus; Humans; Infusions, Intravenous; Labor, Induced; Misoprostol; Oxytocics; Piperidines; Pregnancy; Remifentanil