A woman experiencing incomplete abortion frequently describes passage of clots or pieces of tissue, and reports vaginal bleeding. Medical management of abortion generally involves either a. Infection is centered in the placenta and there is risk of spreading to the uterus, causing pelvic infection or becoming systemic to cause sepsis and potential damage of distant vital organs. Septic abortion is one of the most important causes of maternal mortality ratemmr accounting for % with incidence of bowel injury varying between 518%. In the medical sense, this term and the term miscarriage both refer to the termination of pregnancy before the fetus is capable of survival outside the uterus. Uterine perforation should be suspected when women have unexplained severe abdominal pain and peritonitis. Septic abortion complete or incomplete abortion, induced abortion, criminal abortion organisms. Amenorrhea for 2 months followed by pv bleeding for 11 days after self induced medical. Septic abortion, an infected abortion complicated by fever, endometritis, and parametritis, 1 remains one of the most serious threats to womens health worldwide.
This may not be the complete list of references from this article. The first page of the pdf of this article appears above. An analysis of bowel injury in cases of septic abortion treated over a six. The recommended treatments include antibiotics that have effects on different types of bacteria. An incomplete abortion involves vaginal bleeding, cramping contractions, cervical dilatation, and incomplete passage of the products of conception.
Septic shock in obstetric cases is described, and patient management is discussed. Complications of anesthesia postabortion triad ie, pain, bleeding, lowgrade fever hematometra retained products of conception uterine perforation bowel and bladder injury failed abortion septic abortion cervical shock cervical laceration disseminat. Spontaneous abortion can be subdivided into threatened abortion, inevi table abortion, incomplete abortion, missed abortion, septic abortion, complete abortion, and recurrent spontaneous abortion. When septic abortion is suspected, aerobic and anaerobic cultures of blood are done to help direct antibiotic therapy. Septic shock occurs when an infection overtakes your. A septic abortion is an infection of the placenta and fetus products of conception of a previable pregnancy. Sepsis is the most dreaded complication of abortion. Pdf management of abortion complications at a rural. In septic abortion, infection usually begins as endometritis and involves the endometrium and any retained products of conception. Treatment of septic abortion obgyn coding ask an expert. Management of spontaneous abortion american family physician. Postpartum endometritis refers to infection of the decidua ie, pregnancy endometrium.
I t i s n o w recognized that a sudden fall in blood pressure in a patient with septic abor tion signals the onset of a syndrome which is life threatening and is a. During the 10 years prior to 1968, boston city hospital had a yearly average of. A missed abortion is another term for a missed miscarriage or a silent miscarriage. It is a common cause of postpartum fever and uterine tenderness. The term fetus will be used throughout this discussion, although the term embryo is the. Pyelonephritis retained products of conception septic abortion placenta accreta or percreta neglected chorioamnionitis pneumonia necrotizing fascitis from abdominal incision, episiotomy, perineal laceration. Septic abortion is serious uterine infection during or shortly before or after an abortion. Septic abortion symptoms, diagnosis, treatments and causes. Although abortion services in india were liberalised more than 3 decades ago, access to them remains limited for majority of women. Septic abortion gynecology and obstetrics merck manuals. Comparison with the 23 patients who were more ill exposes a variety. Septic abortion, an abortion associated with infection and complicated by fever, endometritis, and parametritis,1 remains one of the most serious threats to the health of women throughout the world. Endometritis secondary to retained products of conception or using nonsterile instruments.
A quality assessment by a partially completed criterionbased audit. Review of the literature and emergency department management guidelines h. The term abortion is more commonly used as a synonym for induced abortion, the deliberate. Threatened abortion conservative with bed rest and reassurance till bleeding stops. Laboratory tests should include complete blood count cbc with differential, liver function tests, electrolyte levels, glucose, blood urea nitrogen bun, and creatinine. Respecting a clients right to confidentiality absolute respect for the patients right to privacy, discretion. Medical abortion care encompasses the management of various clinical conditions including spontaneous and induced abortion both viable and nonviable pregnancies, incomplete abortion and intrauterine fetal demise, as well as postabortion contraception. A septic abortion is an infection of the placenta and fetus, or products of conception, of a previable pregnancy. Of these, 72 had an uncomplicated recovery after curettage and a hospital stay of 512 days or less. If not treated, the infection may spread further into the myometrium and parametrium. Septic abortion is a threatened, incomplete or missed abortion in which the uterine content has been infected by virulent microorganisms. Cases of septic abortion complicated by septic shock differ from those resulting from bacterial shock. Ashley brandt, in infectious diseases fourth edition, 2017. There are, in addition to chapters on the diagnosis and management of cases of infected abortion, separate ones on endotoxin shock, anerobic uterine infections, pelvic thrombophlebitis, and acute renal failure.
The infection can occur during or just before or after an abortion. A septic abortion is any abortion with infection after a miscarriage or intentional pregnancy termination. Soluble fibrin monomer complexes sfmc were determined in patients with septic abortion body temperatures of more than 39 degree c andor chills without apparent signs of endotoxic shock, with infected abortion, with noninfected abortion and with ncbi. The patient may develop bacteremia and sepsis at any stage of septic abortion. The report of this case of septic abortion is also important at this point of time, when india is going through a new kind of abortion war after introduction of. Septic abortion is usually obvious clinically, typically based on finding severe infection in women who are pregnant. Moran, md edward abraham, md stephen trzeciak, md david t. In the past, obstetriciansgynecologists were often the experts in management of sepsis. The infection can result from factors such as chlamydia, iuds or attempted abortion using infected tools. Spontaneous abortion, or miscarriage, is defined as a clinically recognized pregnancy loss before the 20 th week of gestation 1,2. E management of infected abortions, amer j obstet gynec 85. Full text full text is available as a scanned copy of the original print version.
British pregnancy advisory service head office 89,594 views 3. Septic abortion with hemoglobinuria and renal insufficiency with special. Aviva romm, in botanical medicine for womens health, 2010. If you experience this type of pregnancy loss, you likely wont have the typical symptoms of a miscarriage. The term miscarriage is synonymous and often is used with patients because the word abortion is associated with elective termination. The term septic abortion describes the occurrence of infection developing in or around the uterus during or after an abortion.
The world health organization who defines it as expulsion or extraction of an embryo or fetus weighing 500 g or less. Hormone therapy 400mg natural progesterone in 2divided doses orally or vaginally on empirical basis. Ultrasonography should be done to check for retained products of conception as a possible cause. Septic abortions usually result from induced abortions done by untrained practitioners using nonsterile techniques. Septic abortion gynecology and obstetrics msd manual. Although morbidity and mortality from septic abortion are infrequent in countries in which induced abortion is legal, suffering and death from this process are widespread in many developing countries in which abortion is either illegal or inaccessible.
We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Follow up with ultrasoundpresence of fetal cardiac activity predicts good outcome in 95%of cases. Although morbidity and mortality from septic abortion are infrequent in countries in which induced abortion is legal, suffering and death from this process are widespread in many developing countries in which abortion is either. Pain during and after early medical abortion abortion pill up to 10 weeks duration. Investigation and treatment of septic abortion the bmj. Although most infections are mild and cured with antibiotic therapy, extension of infection to the peritoneal cavity can result in peritonitis, intraabdominal abscess, or sepsis. To study the incidence, socioeconomic and demographic precedent factors, clinical features, management, complications, and maternal. Severe sepsis and septic shock causes in pregnancy sepsis and septic shock in pregnancy can be caused by. The mainstay of treatment of septic abortion is antibiotic therapy alone or in. The genital tract is particularly susceptible to infection at this time and sepsis is often, but not always, consequent to attempts to cause abortion by untrained persons using nonsterilised instruments. Coli, streptococcus, anaerobes bacteroides, sexually transmitted pathogens.
Huang, md, mph tiffany osborn, md dennis stevens, md, phd david a. Spontaneous or induced abortion that is complicated by a pelvic infection. For this reason the author has appropriately emphasized the early diagnosis and aggressive management of septic abortion. Thank you for your interest in spreading the word about the bmj. Medical management of abortion 28 december 2018 expanding health worker roles for safe abortion in the first trimester of pregnancy summary 10 may 2016 health worker roles in providing safe abortion care and postabortion contraception 29 july 2015. Antibiotic treatment is very important for the treatment of septic abortion.
Symptoms and signs symptoms and signs of septic abortion typically appear within 24 to 48 h after abortion and are similar to. Management of abortion complications at a rural hospital in uganda. Abortion is the expulsion of the conceptus before 28 completed weeks of gestation, or a fetus weighing less than 500g. Leading to pid and peritonitis then bacteremia, sepsis, and death. Incomplete abortion an overview sciencedirect topics. Pdf a case of septic abortion unusual presentation.
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