Septic abortion

A septic abortion "is an infection of the placenta and fetus (products of conception) of a previable pregnancy. 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."[1]

Signs and symptoms

In a woman with septic abortion, signs and symptoms that are related to the infection are mainly:

  • High fever, usually above 101 °F / 38 °C
  • Chills
  • Severe abdominal pain and/or cramping /or strong perineal pressure
  • Beginning miscarriage symptoms (heavy bleeding and or cramping) that suddenly stops and does not resume
  • Prolonged or heavy vaginal bleeding
  • Foul-smelling vaginal discharge
  • Backache or heavy back pressure

A cold or urinary tract infection may mimic many of the symptoms.

As the condition becomes more serious, signs of septic shock may appear, including:

Septic shock may lead to kidney failure, bleeding diathesis, and disseminated intravascular coagulation (DIC). Intestinal organs may also become infected, potentially causing scar tissue with chronic pain, intestinal blockage, and infertility.

If the septic abortion is not treated quickly and effectively, the woman may die.

Causes

Septic abortion is often a complication of an infection of the upper genital tract by multiple strains of gram positive and/or gram negative bacteria. Septic abortion can occur when these bacteria enter the uterus or even when the natural vaginal flora becomes pathogenic.[2] Also, sexually transmitted infections (STI) such as chlamydia may cause septic abortion.

Risk factors

The risk of a septic abortion is increased by mainly the following factors:

  • The fetal membranes surrounding the fetus have ruptured, sometimes without being detected
  • The woman has a sexually transmitted infection such as chlamydia
  • An intrauterine device (IUD) was left in place during the pregnancy
  • Tissue from the fetus or placenta is left inside the uterus after a miscarriage or elective abortion procedure
  • Unsafe abortion was made to end the pregnancy
  • Insertion of tools, chemicals, or soaps into the uterus

Treatment

The woman should have intravenous fluids to maintain blood pressure and urine output (oliguria or hypouresis are both names from roots meaning "not enough urine;" these terms refer to the low output of urine). Broad-spectrum intravenous antibiotics should be given until the fever is gone. There are different antibiotic regimens which are almost equal such as intravenous clindamycin, penicillin plus chloramphenicol, cephalothin plus kanamycin.[2] And only one research found that tetracycline is more effective to decrease the time of fever than penicillin G.[2] However, new studies are needed to establish the most effective antibiotic in septic abortion.[2]

A dilatation and curettage (D&C) or misoprostol may be needed to clean the uterus of any residual tissue. Rh negative blood should be given to the patient in addition to an injection of Rh immune globulin, unless the father is also known to be Rh negative. In cases so severe that abscesses have formed in the ovaries and tubes, it may be necessary to remove the uterus by hysterectomy, and possibly other infected organs as well.

After successful treatment of a septic abortion, a woman may be tired for several weeks. In case of substantial bleeding, iron supplementation may be helpful. Sexual intercourse or the use of tampons should be avoided until recommended by the healthcare provider.

References
  1. Eschenbach DA (May 2015). "Treating spontaneous and induced septic abortions". Obstetrics and Gynecology. 125 (5): 1042–8. doi:10.1097/AOG.0000000000000795. PMID 25932831.
  2. Udoh A, Effa EE, Oduwole O, Okusanya BO, Okafo O, et al. (Cochrane Fertility Regulation Group) (July 2016). "Antibiotics for treating septic abortion". The Cochrane Database of Systematic Reviews. 7: CD011528. doi:10.1002/14651858.CD011528.pub2. PMC 6458041. PMID 27364644.
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