Laboratory tests should include complete blood count cbc with differential, liver function tests, electrolyte levels, glucose. Septic abortion gynecology and obstetrics merck manuals. 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. Pdf file of the complete article 157k, or click on a page image below to browse page by page. Incomplete abortion an overview sciencedirect topics. Full text full text is available as a scanned copy of the original print version. The term septic abortion describes the occurrence of infection developing in or around the uterus during or after an abortion. Complications of spontaneous miscarriages and therapeutic abortions include the following. Diagnosis of septic abortion with pointofcare ultrasound. Ashley brandt, in infectious diseases fourth edition, 2017.
Endometritis secondary to retained products of conception or using nonsterile instruments. Aug 22, 2017 while rare in developed countries, septic abortion is a lifethreatening infection of the placenta and fetus of a previable pregnancy typically associated with unsafe abortion practices. Of these, 72 had an uncomplicated recovery after curettage and a hospital stay of 512 days or less. The management of incomplete abortion and retained poc depends on clinical presentation. Update in obstetric maternal sepsis clinical articles. 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.
Septic abortion with hemoglobinuria and renal insufficiency with special. Antibiotic treatment is very important for the treatment of septic abortion. The patient may develop bacteremia and sepsis at any stage of septic abortion. For this reason the author has appropriately emphasized the early diagnosis and aggressive management of septic abortion. 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. Oct 01, 2005 spontaneous abortion, which is the loss of a pregnancy without outside intervention before 20 weeks gestation, affects up to 20 percent of recognized pregnancies. Septic abortion is serious uterine infection during or shortly before or after an abortion. Laboratory tests should include complete blood count cbc with differential, liver function tests, electrolyte levels, glucose, blood urea nitrogen bun, and creatinine. Apr 19, 2019 abortion with septic shock is a medical emergency.
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. This study is to evaluate, once again, the clinical management and prognosis of septic abortion, and to determine if present concepts of therapy are valid. The world health organization who defines it as expulsion or extraction of an embryo or fetus weighing 500 g or less. Spontaneous abortion, or miscarriage, is defined as a clinically recognized pregnancy loss before the 20 th week of gestation 1,2. 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.
Amenorrhea for 2 months followed by pv bleeding for 11 days. Septic abortion definition of septic abortion by medical. Investigation and treatment of septic abortion the bmj. Amenorrhea for 2 months followed by pv bleeding for 11 days after self induced medical abortion at 7wk and 2 days of. 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. Spontaneous abortion can be subdivided into threatened abortion, inevi table abortion, incomplete abortion, missed abortion, septic abortion, complete abortion, and recurrent spontaneous abortion. Septic abortions usually result from induced abortions done by untrained practitioners using nonsterile techniques. Septic abortion symptoms, diagnosis, treatments and causes. Severe sepsis and septic shock causes in pregnancy sepsis and septic shock in pregnancy can be caused by. A quality assessment by a partially completed criterionbased audit. If a patient has been bleeding heavily or presents with clinical signs and symptoms of infection, surgical evacuation is indicated, and medical management is inappropriate. Thank you for your interest in spreading the word about the bmj. Jun 24, 2016 complications of spontaneous miscarriages and therapeutic abortions include the following. This may not be the complete list of references from this article.
Pyelonephritis retained products of conception septic abortion placenta accreta or percreta neglected chorioamnionitis pneumonia necrotizing fascitis from abdominal incision, episiotomy, perineal laceration. Abortion is the expulsion of the conceptus before 28 completed weeks of gestation, or a fetus weighing less than 500g. A septic abortion is any abortion with infection after a miscarriage or intentional pregnancy termination. Medical management of abortion generally involves either a. The international consensus conference has launched new definition for sepsis and septic shock. Get a printable copy pdf file of the complete article 523k, or click on a page image below to browse page by page. Management of septic abortion europe pmc article europe. A woman experiencing incomplete abortion frequently describes passage of clots or pieces of tissue, and reports vaginal bleeding. 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 post abortion contraception. An incomplete abortion involves vaginal bleeding, cramping contractions, cervical dilatation, and incomplete passage of the products of conception. Comparison with the 23 patients who were more ill exposes a variety. 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. If not treated, the infection may spread further into the myometrium and parametrium. Septic abortion gynecology and obstetrics msd manual.
The management of septic abortion in an intensive care. Medical abortion care plays a crucial role in providing access to safe, effective and acceptable abortion care. 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 post abortion contraception 29 july 2015. The first page of the pdf of this article appears above. 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. Of patients subjected to hysterectomy, the mortality is now 20%, as opposed to 37% prior to the advent of icu. 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. A septic abortion is an infection of the placenta and fetus, or products of conception, of a previable pregnancy. Jun 24, 2017 pain during and after early medical abortion abortion pill up to 10 weeks duration. Hormone therapy 400mg natural progesterone in 2divided doses orally or vaginally on empirical basis. Respecting a clients right to confidentiality absolute respect for the patients right to privacy, discretion.
Septic abortion, an infected abortion complicated by fever, endometritis, and parametritis, 1 remains one of the most serious threats to womens health worldwide. In both high and lowresource settings, the use of medical methods of abortion have. The term abortion is more commonly used as a synonym for induced abortion, the deliberate. While rare in developed countries, septic abortion is a lifethreatening infection of the placenta and fetus of a previable pregnancy typically associated with unsafe abortion practices. The recommended treatments include antibiotics that have effects on different types of bacteria. The infection can result from factors such as chlamydia, iuds or attempted abortion using infected tools.
Pdf management of abortion complications at a rural. British pregnancy advisory service head office 89,594 views 3. When septic abortion is suspected, aerobic and anaerobic cultures of blood are done to help direct antibiotic therapy. Spontaneous or induced abortion that is complicated by a pelvic infection. Follow up with ultrasoundpresence of fetal cardiac activity predicts good outcome in 95%of cases. The diagnosis of septic abortion should be considered in any woman who has a temperature of 38 c 100. In septic abortion, infection usually begins as endometritis and involves the endometrium and any retained products of conception.
Symptoms and signs symptoms and signs of septic abortion typically appear within 24 to 48 h after. The term fetus will be used throughout this discussion, although the term embryo is the. Nursing management intense maternal monitoring mgso4 administration antihypertensive medications depending on the condition of mother and fetus, delivery might be indicated electronic fetal monitoring 1. Threatened abortion conservative with bed rest and reassurance till bleeding stops.
Treatment of septic abortion obgyn coding ask an expert. Medical management of abortion generally involves either a combination regimen of mifepristone and misoprostol or a misoprostolonly regimen. 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 a draft of the medical. Pdf a case of septic abortion unusual presentation. Septic abortion is one of the most important causes of maternal mortality ratemmr accounting for % with incidence of bowel injury varying between 5.
The value of icu treatment in the management of septic abortion has been assessed. The diagnosis of septic abortion is difficult to make with certainty. Jun 24, 2016 in septic abortion, infection usually begins as endometritis and involves the endometrium and any retained products of conception. Pain during and after early medical abortion abortion pill up to 10 weeks duration. Management of abortion complications at a rural hospital in uganda. Get a printable copy pdf file of the complete article. 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. Sepsis is defined as lifethreatening organ dysfunction caused by a dysregulated host response to infection. The management of septic abortion in an intensive care unit.
Abortion is a medical term for the disruption of a pregnancy before the fetus reaches its viable age of more than 20 to 24 weeks of gestation or weighs at least 500g. Leading to pid and peritonitis then bacteremia, sepsis, and death. A septic abortion is an infection of the placenta and fetus products of conception of a previable pregnancy. Although abortion services in india were liberalised more than 3 decades ago, access to them remains limited for majority of women. Management of spontaneous abortion american family physician. Septic shock occurs when an infection overtakes your body and causes very low blood pressure. Coli, streptococcus, anaerobes bacteroides, sexually transmitted pathogens. It would therefore appear that these patients can benefit from intensive nursing and medical attention. Hormone therapy 400mg natural progesterone in 2divided doses orally or vaginally on.
Pathophysiology the most common cause of an abortion is abnormal fetal development, which is either due to a chromosomal aberration or a teratogenic factor. 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. Aviva romm, in botanical medicine for womens health, 2010. 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. The infection can occur during or just before or after an abortion. Septic abortion complete or incomplete abortion, induced abortion, criminal abortion organisms. Septic abortion is one of the most important causes of maternal mortality ratemmr accounting for % with incidence of bowel injury varying between 518%. Septic abortion, an abortion associated with infection and complicated by fever, endometritis, and parametritis,1 remains one of the most serious threats to.