Necrotizing Uterine Infection After Dilation and Evacuation: A Case Report

Previable premature prelabor rupture of membranes (PPROM) can lead to uterine infection, and sepsis with uterine necrosis is a rare complication. Prompt source control with abortion care if infection develops is an important component of management. We report the case of uterine necrosis in an immunosuppressed patient. A 25-year-old gravida 5, para 1-0-3-1, on immunosuppressive medications for systemic lupus erythematosus, presented at 15 weeks with PPROM and sepsis. She was treated with broad-spectrum intravenous antibiotics and dilation and evacuation (D&E) for a septic abortion. Her clinical status did not improve postoperatively, and workup, including imaging, revealed an ascending infection with a uterine source. After counseling, she underwent total abdominal hysterectomy with uterine necrosis confirmed on pathologic examination. Endometrial cultures grew multiple organisms sensitive to the antibiotic regimen. The patient recovered and was discharged on postoperative day five. Uterine necrosis can be a severe complication of septic abortion and presents as worsening pain and sepsis despite uterine evacuation. Non-toxin and non-gas-producing bacteria can be implicated. A high index of suspicion is required for appropriate treatment, particularly for immunosuppressed patients. Definitive surgical management of uterine necrosis with hysterectomy should be considered.