Septic miscarriage

O03.0/O08.0 + (A41.9/N71.0/R57.2)

GENERAL MEASURES

Counselling.
Urgent evacuation of uterus (under general anaesthesia and not a MVA) and surgical management of complications.

MEDICINE TREATMENT

  • Oxytocin, IV.
    • Dilute 20 units in 1 L sodium chloride 0.9%, i.e. 20 milliunits/mL solution administered at a rate of 125 mL/hour.
    • Reduce rate if strong contractions are experienced.

Antibiotic therapy

  • Amoxicillin/clavulanic acid, IV, 1.2 g, 8 hourly.

Change to oral treatment after clinical improvement:

  • Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 7–10 days.

Note: The addition of metronidazole to amoxicillin/clavulanic acid is unnecessary as amoxicillin/clavulanic acid has adequate anaerobic cover.

LoEIII

Severe penicillin allergy: (Z88.0)

  • Clindamycin, IV, 600 mg 8 hourly.

AND

  • Gentamicin, IV, 6 mg/kg daily (see GENTAMICIN, IV for guidance on prescribing).

Change to oral treatment after improvement:

  • Clindamycin, oral, 450 mg 8 hourly for 5 days.

AND

  • Ciprofloxacin, oral, 500 mg 12 hourly for 5 days.

Note: The addition of metronidazole to clindamycin is unnecessary as clindamycin has adequate anaerobic cover.

If patient has severe sepsis, consider urgent hysterectomy.


REFERRAL

  • Evidence of trauma.
  • No response to treatment within 48 hours.