July 4, 2007: Sepsis and Death after "Medication Abortion"

"Sabrina" Roe was 18 years old and 6.5 weeks pregnant in the summer of 2007. Pregnant for the first time, she went to an provider somewhere in the United States for a "medication abortion." She was given 200 mg of oral mifepristone, a drug that causes the placenta to deteriorate and causes the embryo to die for lack of oxygen and nutrition.

It's unclear if she was administered the second dose at the facility or was given it to take at home, but 2 days after the mifepristone she was administered 800 mgcg of misoprostol inside her cheek. This second drug is to cause the contractions that will expel the dead embryo.

For 2 or 3 days Sabrina experienced only moderate bleeding and cramping. However by the fifth day, she suffered chills, dizziness, abdominal pain, nausea, and vomiting. Over the next day the symptoms only got worse, so Sabrina went to "her outpatient clinic" -- likely the abortion facility that had given her the drugs. In spite of her chills, they determined that she didn't have a fever. She had pain throughout her lower abdomen and pelvic tenderness. She was diagnosed with bacterial vaginosis, given a prescription for metronidazole and doxycycline, and sent home. 

Somehow they didn't make a connection between an infection in her vagina and the possibility that she was developing potentially fatal sepsis.

The following day she was in even worse condition, so at last the clinic sent her to the emergency room. Her blood pressures was a low 56/21 (normal is around 120/80) and a rapid heartbeat of 149 (normal is around 60-100). Though she still had no fever, she had an elevated white blood cell count (indicative of infection) and an elevated hematocrit of 60.1%, which can be a sign of dehydration. 

Staff at the ER performed an ultrasound and found a large amount of free fluid and a cystic mass in her pelvic cavity. Doctors performed an exploratory laparotomy and found about 2.5 liters of cloudy fluid in her pelvic cavity, fluid swelling of the fallopian tubes, and inflammation of her peritoneum (lining of the abdomen). 

They admitted Sabrina to the ICU, where she was treated with IV fluids and an intensive cocktail of antibiotics for presumed sepsis. On July 4, just 16 hours after being admitted to the emergency room, Sabrina went into cardio-respiratory arrest and died.

An autopsy found findings consistent with necrotizing endometritis and sepsis.

HT: killed-by-choice

Sources:

• "Clostridial Toxic Shock After Abortion," Obstetrics & Gynecology, November 2007
• FDA Adverse Events Reporting System