While most recoveries are straightforward after a miscarriage, a potential complication is a uterine infection, often called endometritis or, in severe cases, a septic miscarriage. This infection occurs when bacteria enter the uterus, sometimes stemming from retained tissue that did not pass completely. An infection in the reproductive tract is a serious medical event that can rapidly lead to life-threatening conditions like sepsis if not addressed immediately. Anyone experiencing unusual symptoms must contact a healthcare provider or go to an Emergency Department immediately.
Recognizing the Signs of Post-Miscarriage Infection
Identifying a potential infection quickly depends on recognizing specific physical changes. The most distinct sign is a high fever, generally considered above 100.4°F (38°C), which may be accompanied by noticeable chills or shivering. This temperature elevation signifies the body’s systemic response to a bacterial presence.
Severe abdominal pain or cramping that progressively worsens and is not relieved by standard over-the-counter pain medication can indicate an infection in the uterus. This pain may be localized to the lower abdomen and feel tender to the touch.
A change in vaginal discharge is a key indicator, particularly a foul-smelling odor or a discharge that appears yellowish or greenish. While some bleeding and discharge are expected, a sudden increase in the heaviness of the bleeding or bleeding that continues for longer than expected warrants immediate medical attention. Any combination of these symptoms suggests the need for urgent professional assessment.
Medical Diagnosis and Assessment
When seeking medical care, the physician will conduct a thorough assessment, including a pelvic exam, to check for uterine tenderness and the presence of purulent, or pus-like, discharge from the cervix. This hands-on evaluation helps confirm localized pain. Laboratory work will also be ordered to look for evidence of a systemic inflammatory response.
Blood tests check the white blood cell (WBC) count, which is typically elevated in the presence of infection. Inflammatory markers, such as C-reactive protein (CRP), may also be measured, as these non-specific proteins increase rapidly in response to inflammation. Blood cultures may be drawn to identify the specific type of bacteria causing the infection, which is crucial for tailoring the antibiotic treatment.
Imaging studies, especially an ultrasound, are necessary to determine the condition of the uterus. The ultrasound checks for retained products of conception (RPOC), which are often the underlying source of the infection. Identifying retained tissue guides the decision-making process for the necessary treatment.
Standard Treatment Protocols
The immediate treatment for a confirmed post-miscarriage infection is the administration of broad-spectrum antibiotics. In cases of significant fever or systemic illness, the initial course of antibiotics is given intravenously (IV) to ensure rapid concentrations reach the infected uterine tissue. Common IV regimens involve a combination of antibiotics, such as clindamycin and gentamicin, which target the various types of bacteria likely to be involved.
Hospitalization is often required to monitor the patient’s response to IV antibiotics and ensure stability. Once the fever has resolved and the patient’s condition has improved, they are transitioned to an oral antibiotic regimen to complete the course at home. The total duration usually lasts between seven to ten days.
If the ultrasound confirms retained products of conception, a surgical procedure is necessary to remove this infected tissue. This procedure is known as a dilation and curettage (D&C) or suction aspiration, which removes the contents of the uterus. Surgical clearance is performed in conjunction with antibiotic treatment, as removing the source of the infection is paramount for complete resolution.
Follow-up Care and Monitoring Recovery
Completing the full course of prescribed oral antibiotics is required for recovery, even if symptoms subside quickly. Stopping the medication prematurely risks a relapse of the infection or the development of antibiotic-resistant bacteria. Patients should continue to monitor their temperature and watch for any return of foul-smelling discharge or worsening pain.
A follow-up appointment with the healthcare provider is essential, usually scheduled within a week or two after the acute treatment phase. During this visit, the physician will confirm that the infection has cleared and the uterus is healing properly. This may involve repeating blood work to ensure inflammatory markers have decreased to a normal range.
The physical recovery from a uterine infection requires rest. Patients should be advised to avoid placing anything into the vagina, such as tampons, and to refrain from sexual intercourse until the physician has cleared them. Emotional recovery is also a significant component of care, and patients should be encouraged to seek support for the grief associated with the miscarriage.