FATAL CLOSTRIDIUM-PERFRINGENS AND ESCHERICHIA-COLI SEPSIS FOLLOWING UREA-INSTILLATION ABORTION

Intraamniotic instillation of urea is a common mode of legal second-tr imester pregnancy termination. Associated mortality rarely occurs and is most commonly due to amniotic fluid embolism, pulmonary thromboembo lism, infection, hemorrhage, and disseminated intravascular coagulatio n (DIC). We present the case of an 18-year-old gravida 2, para 1 white woman at 18 weeks' gestation who underwent intraamniotic instillation of hyperosmolar urea and intracervical insertion of laminaria tents; 19 h later, she became unresponsive, acidemic, and went into shock. Co agulation studies were diagnostic of DIC. Bacilli were seen on periphe ral blood smear. Autopsy showed marked subcutaneous emphysema of the a nterior abdominal wall, necrosis and emphysema of the uterus, diffuse pulmonary alveolar damage, and renal cortical necrosis. Antemortem blo od cultures grew Clostridium perfringens and Escherichia coli. Postmor tem culture of the uterus grew E. coli. The source of infection was mo st likely the introduction of vaginal organism via laminaria insertion . This is apparently the first reported case of death caused by Clostr idium perfringens and E. coli sepsis following urea instillation.