A patient at 17 weeks’ gestation is diagnosed with an intrauterine fetal demise. She desires expectant management. She returns to your office 5 weeks later, and her vital signs are—blood pressure 110/72 mm Hg, pulse 93 beats per minute, temperature 36.38°C, respiratory rate 16 breaths per minute. She has not had a miscarriage, although she has had some occasional spotting. Her cervix is closed on examination.
This patient is at increased risk for which of the following?a. Septic abortion
In women with intrauterine fetal demise, labor usually occurs within 2 weeks. Women are typically offered expectant management versus active management with surgical or medical evacuation of the uterus. If the fetus is retained longer than 1 month, 25% of women can develop coagulopathy, which is manifested by decreased fibrinogen, elevated fibrin degradation products, and decreased platelets. Septic abortions were more frequently seen during the era of illegal abortions, although occasionally sepsis can occur if there is incomplete evacuation of the products of conception in either a therapeutic or spontaneous abortion. However, since her cervix is closed and no tissue has passed, septic abortion is unlikely. Intrauterine fetal demise has no impact on future fertility or association with ectopic pregnancies.