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Febrile Abortion – Causes, Symptoms and Treatment

A febrile abortion is a miscarriage accompanied by fever and signs of infection. It is a medical emergency requiring immediate treatment.

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Things worth knowing about "Febrile Abortion"

A febrile abortion is a miscarriage accompanied by fever and signs of infection. It is a medical emergency requiring immediate treatment.

What Is a Febrile Abortion?

A febrile abortion is a miscarriage that occurs alongside fever and signs of infection. It involves a bacterial infection of the uterus and, in severe cases, surrounding organs or the entire body. A febrile abortion is a gynecological emergency that can become life-threatening without prompt treatment.

Causes

Febrile abortion results from a bacterial infection associated with the miscarriage. Common contributing factors include:

Ascending infection from the vagina or cervix
Incomplete miscarriage with retained tissue in the uterus, which provides a breeding ground for bacteria
Improperly performed procedures (e.g., unsafe or illegal abortions)
Pre-existing genital infections

Typical pathogens include Staphylococci, Streptococci, Escherichia coli, and anaerobic bacteria such as Clostridium perfringens.

Symptoms

Symptoms of febrile abortion vary in severity and may include:

Fever (body temperature above 38 °C / 100.4 °F)
Chills and shivering
Lower abdominal pain and uterine tenderness
Foul-smelling or purulent vaginal discharge
Vaginal bleeding
General malaise, weakness, and fatigue
In severe cases: signs of sepsis (life-threatening systemic infection), such as rapid heart rate, low blood pressure, and altered consciousness

Diagnosis

Diagnosis of febrile abortion is based on a combination of clinical examination and medical testing:

Gynecological examination: Assessment of the cervix and uterine tenderness or enlargement
Ultrasound (sonography): Detection of retained tissue in the uterus and assessment of possible complications
Blood tests: Elevated inflammatory markers (CRP, white blood cell count), complete blood count, and coagulation status
Swabs and blood cultures: Identification of the causative pathogen for targeted antibiotic therapy

Treatment

Febrile abortion requires immediate and intensive medical care, typically in a hospital setting:

Antibiotic Therapy

Intravenous administration of broad-spectrum antibiotics is the cornerstone of treatment. It is initiated as quickly as possible and tailored to the suspected or confirmed pathogen to prevent further spread of infection.

Surgical Evacuation

If retained tissue remains in the uterus, a curettage (uterine scraping) or vacuum aspiration is performed to remove the source of infection. This procedure should be carried out under antibiotic cover.

Intensive Care for Sepsis

In cases of sepsis or septic shock, intensive care unit admission is necessary. This includes circulatory stabilization, fluid therapy, and additional supportive measures as needed.

Follow-up Care

After recovery, regular follow-up appointments are important to detect and treat potential complications such as intrauterine adhesions (Asherman syndrome) at an early stage.

Complications

Without timely treatment, febrile abortion can lead to serious complications:

Spread of infection to the fallopian tubes, ovaries, and abdominal cavity (peritonitis)
Sepsis and septic shock
Multi-organ failure
Infertility due to scarring of the uterus or fallopian tubes

Prevention

The following measures help reduce the risk of febrile abortion:

Proper medical care during miscarriage or termination of pregnancy
Early treatment of genital infections during pregnancy
Regular prenatal check-ups throughout pregnancy
Access to safe and legal abortion services

References

World Health Organization (WHO): Safe abortion: technical and policy guidance for health systems. 2nd edition. Geneva 2012. Available at: https://www.who.int
Cunningham F.G. et al.: Williams Obstetrics. 25th edition. McGraw-Hill Education, New York 2018.
Royal College of Obstetricians and Gynaecologists (RCOG): The Management of Early Pregnancy Loss. Green-top Guideline No. 25. London 2011.

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