Septic miscarriage with shock — emergency management station

Team-based emergency station: septic miscarriage with septic shock in a regional unit. Tests sepsis recognition and the one-hour bundle, the decision to evacuate a septic uterus, escalation and transfer thresholds, and closed-loop team communication. Includes assessor key and marking domains.

Prompt

A 24-year-old G3P1 presents to a regional emergency department at 02:00. She passed tissue at home 36 hours ago at 11 weeks and has since become progressively unwell. Temperature 39.1 degrees Celsius, pulse 132 beats per minute, blood pressure 82/44 mmHg, respiratory rate 26, oxygen saturation 96 per cent on air. She has offensive vaginal loss, exquisite uterine tenderness and cool peripheries. You are the on-call gynaecology registrar; the consultant is 25 minutes away and the theatre team is being called in.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the gynaecology registrar in a regional hospital at 02:00. An emergency nurse and an emergency physician are with you; the gynaecology consultant is 25 minutes away and the anaesthetist is in the building. The assessor runs the clock and feeds new observations. ^[1]

Candidate instruction. Lead the resuscitation and definitive management of septic miscarriage with shock. Verbalise your actions, your drug orders, your escalation triggers and your communication with the team, the consultant and the patient. ^[1]

References6Show

[1]Coomarasamy A, Gallos ID, Papadopoulou A, et al. Sporadic miscarriage: evidence to provide effective care Lancet, 2021.PMID 33915095
[3]Quenby S, Gallos ID, Dhillon-Smith RK, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss Lancet, 2021.PMID 33915094
[4]Nanda K, Lopez LM, Grimes DA, et al. Expectant care versus surgical treatment for miscarriage Cochrane Database Syst Rev, 2012.PMID 22419288
[5]Farren J, Jalmbrant M, Falconieri N, et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study Am J Obstet Gynecol, 2020.PMID 31953115
[6]Memtsa M, Johns J, Jurkovic D, et al. Diagnosis and outcome of hydatidiform moles in missed-miscarriage: a cohort-study, systematic review and meta-analysis Eur J Obstet Gynecol Reprod Biol, 2020.PMID 32877774
[7]Royal Australian and New Zealand College of Obstetricians and Gynaecologists Miscarriage, Recurrent Miscarriage and Ectopic Pregnancy (C-Gyn 38) RANZCOG Clinical Guideline, 2025.Source

Septic miscarriage with shock — emergency management station

Station brief

References6Show

[1]Coomarasamy A, Gallos ID, Papadopoulou A, et al. Sporadic miscarriage: evidence to provide effective care Lancet, 2021.PMID 33915095
[3]Quenby S, Gallos ID, Dhillon-Smith RK, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss Lancet, 2021.PMID 33915094
[4]Nanda K, Lopez LM, Grimes DA, et al. Expectant care versus surgical treatment for miscarriage Cochrane Database Syst Rev, 2012.PMID 22419288
[5]Farren J, Jalmbrant M, Falconieri N, et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study Am J Obstet Gynecol, 2020.PMID 31953115
[6]Memtsa M, Johns J, Jurkovic D, et al. Diagnosis and outcome of hydatidiform moles in missed-miscarriage: a cohort-study, systematic review and meta-analysis Eur J Obstet Gynecol Reprod Biol, 2020.PMID 32877774
[7]Royal Australian and New Zealand College of Obstetricians and Gynaecologists Miscarriage, Recurrent Miscarriage and Ectopic Pregnancy (C-Gyn 38) RANZCOG Clinical Guideline, 2025.Source