Postabortal septic shock masquerading as haemorrhagic shock

A multiparous woman in her mid-30s presented with 8 days of vaginal bleeding following an unplanned, unsupervised pregnancy. She had a history of trauma and expulsion of tissue per vaginum at 12 weeks of gestation but did not seek medical care. On arrival, she was in haemorrhagic shock with severe anaemia (haemoglobin 5.9 g/dL), thrombocytopenia and hypotension. Initial management included fluid resuscitation, blood transfusions, vasopressors and broad-spectrum antibiotics. Despite stabilisation, persistent tachycardia, abdominal tenderness and a rising respiratory rate raised concern for sepsis. A clinical diagnosis of septic shock was made, prompting emergency laparotomy, which revealed pyoperitoneum. Cultures identified Streptococcus pyogenes; antibiotics were escalated to meropenem and vancomycin. The patient required intensive care unit care with mechanical ventilation and inotropic support. She recovered well postoperatively, developed a minor surgical site infection managed conservatively and was discharged in stable condition. Follow-up confirmed full recovery, and appropriate contraceptive counselling was provided.