Severe Acute Maternal Morbidity Associated with Septic Abortion: A Case Report

Abstract

BACKGROUND: Massive upper gastrointestinal haemorrhage (UGIH) is a common surgical emergency. It is however uncommon for it to present as the only site of bleeding in a patient with septic abortion. OBJECTIVE: To report a case of the occurrence of non-steroidal anti-inflammatory drug (NSAID)-induced gastropathy as a cause of massive UGIH in a patient with septic abortion. CASE REPORT: A 19-year-old woman presented with fever and bleeding per vaginam and haematemesis about two weeks after an unsafe abortion. Examination revealed a young woman in shock. She was fully investigated and successfully resuscitated RESULTS: She had intractable haematemesis which was initially suspected to be due to disseminated intravascular coagulopathy. She was rhesus negative. The haematemesis was subsequently found at endoscopy to be due to acute upper gastrointestinal ulceration following non-steroidal antiinflammatory drug abuse. She had, among other treatments, 13 units of rhesus negative blood transfused, intensive care and triple therapy for the UGIH, anti-D immunoglobulin administration and manual vacuum aspiration for retained products of conception. She recovered fully. CONCLUSION: Severe acute maternal morbidity can be due to several causes. A high index of suspicion for unusual causes such as non-steroidal anti-inflammatory induced gastropathy and prompt appropriate multidisciplinary approach to management are key to a favourable outcome. BJM 2017; 1(1): 23–25.