What is the risk of Pelvic Inflammatory Disease (PID) after a spontaneous abortion (miscarriage)?

From the Guidelines

PID after a miscarriage is a serious condition that requires immediate medical attention to prevent long-term complications such as infertility, chronic pelvic pain, and ectopic pregnancy. Pelvic Inflammatory Disease (PID) can occur after a miscarriage due to bacteria ascending from the vagina into the upper reproductive tract during or after the miscarriage process. According to the guidelines for prevention and management of PID 1, women with PID are at increased risk of chronic pelvic pain, ectopic pregnancy, and tubal infertility.

Key Considerations

• The risk of ectopic pregnancy increases sevenfold compared to women with no history of PID after one episode of PID 1.
• Approximately 12% of women are infertile after a single episode of PID, almost 25% after two episodes, and over 50% after three or more episodes 1.
• Other sequelae associated with PID include dyspareunia, pyosalpinx, tubo-ovarian abscess, and pelvic adhesions 1.

Treatment Approach

• The standard treatment involves a broad-spectrum antibiotic regimen, and it is essential to complete the full course of treatment as prescribed.
• During treatment, it is crucial to abstain from sexual activity and attend follow-up appointments to ensure complete resolution of the infection.
• Hospitalization may be necessary for severe cases, especially if there's high fever, severe pain, nausea/vomiting, or pregnancy. PID after miscarriage occurs because the cervix may remain slightly dilated during the miscarriage process, allowing bacteria easier access to the upper reproductive tract, while the endometrial lining is also more vulnerable during this time of tissue breakdown and healing. Prompt treatment is essential to prevent these complications, and seeking medical attention immediately is crucial if PID is suspected after a miscarriage.

From the Research

Pelvic Inflammatory Disease (PID) after Miscarriage

• PID is an infection of the upper genital tract that can occur after a miscarriage, especially if the miscarriage was incomplete or if instruments were used to remove tissue from the uterus 2.
• The risk of developing PID after a miscarriage is higher if the woman has a history of pelvic inflammatory disease, sexually transmitted infections, or if she has had multiple sexual partners 2.

Diagnosis and Treatment of PID

• The diagnosis of PID is typically made based on clinical symptoms, such as lower abdominal pain, fever, and abnormal vaginal discharge 2.
• The treatment of PID usually involves antibiotics, such as ceftriaxone and doxycycline, which are effective against a wide range of bacteria that can cause PID 2, 3.
• In some cases, metronidazole may be added to the treatment regimen to cover anaerobic bacteria, which can also cause PID 3.

Antibiotic Regimens for PID

• Different antibiotic regimens have been studied for the treatment of PID, including ceftriaxone plus doxycycline, ceftriaxone plus azithromycin, and moxifloxacin plus ceftriaxone 4, 5, 6.
• The choice of antibiotic regimen may depend on the severity of the infection, the presence of other medical conditions, and the susceptibility of the bacteria to different antibiotics 4, 6.

Prevention of PID after Miscarriage

• To prevent PID after a miscarriage, it is essential to ensure that the uterus is completely empty and that any instruments used to remove tissue are sterile 2.
• Women who have had a miscarriage should be screened for sexually transmitted infections and treated if necessary to reduce the risk of developing PID 2.