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Septic miscarriage — DRCOG MCQ

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HardEarly PregnancySeptic miscarriageDRCOG

A 27-year-old woman at 10 weeks presents with heavy vaginal bleeding, lower abdominal pain and fever. She reports passing tissue 2 days ago. Temperature is 38.7°C, pulse 122 bpm and the uterus is tender. What is the most likely diagnosis?

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Correct answer: C — Septic miscarriage

Fever, tachycardia, uterine tenderness and recent passage of tissue indicate septic miscarriage until proven otherwise. Threatened miscarriage would not cause systemic infection signs. Ectopic pregnancy remains important in early pregnancy pain, but the history of tissue passage and uterine tenderness with fever points to infected miscarriage. The pearl is that sepsis features in early pregnancy bleeding need emergency treatment rather than routine early pregnancy follow-up.

Reference: NICE NG126; NICE NG51